PERIAMPULLARY ADENOCARCINOMA - ANALYSIS OF 5-YEAR SURVIVORS

Objective This single-institution experience retrospectively reviews t he outcomes in a group of patients treated 5 or more years ago by panc reaticoduodenectomy for periampullary adenocarcinoma. Summary Backgrou nd Data Controversy exists regarding the benefit of resection for peri ampullary adenocarcinoma, particularly for pancreatic: tumors. Many se ries report only Kaplan-Meier actuarial 5-year survival rates. There a re believed to be discrepancies between the actuarial 5-year survival data and the actual 5-year survival rates. Methods From April 1970 thr ough May 1992, 242 patients underwent pancreaticoduodenal resection fo r periampullary adenocarcinoma at The Johns Hopkins Hospital. Follow-u p was complete through May 1997. All pathology specimens were reviewed and categorized. Actual 5-year survival rates were calculated. The de mographic, intraoperative, pathologic, and postoperative features of p atients surviving greater than or equal to 5 years were compared with those of patients who survived <5 years. Results Of the 242 patients w ith resected periampullary adenocarcinoma, 149 (62%) were pancreatic p rimaries, 46 (19%) arose in the ampulla, 30 (12%) were distal bile duc t cancers, and 17 (7%) were duodenal cancers. There was a 5.3% operati ve mortality rate during the 22 years of the review, with a 2% operati ve mortality rate in the last 100 patients. There were 58 5-year survi vors, 28 7-year survivors, and 7 10-year survivors. The tumor-specific 5-year actual survival rates were pancreatic 15%,ampullary 39%, dista l bile duct 27%, and duodenal 59%. When compared with patients who did not survive 5 years,the 5-year survivors had a significantly higher p ercentage of well-differentiated tumors (14% vs. 4%; p = 0.02) and hig her incidences of negative resection margins (98% vs. 73%, p < 0.0001) and negative nodal status (62% vs. 31%, p < 0.0001). The tumor-specif ic 10-year actuarial survival rates were pancreatic 5%, ampullary 25%, distai bile duct 21%, and duodenal 59%. Conclusions Among patients wi th periampullary adenocarcinoma treated by pancreaticoduodenectomy, th ose with duodenal adenocarcinoma are most likely to survive long term. Five-year survival is less likely for patients with ampullary, distal bile duct, and pancreatic primaries, in declining order. Resection ma rgin status, resected lymph node status, and degree of tumor different iation also significantly influence long-term outcome. Particularly fo r patients with pancreatic adenocarcinoma, 5-year survival is not equa ted with cure, because many patients die of recurrent disease >5 years after resection.