Factors influencing survival after resection for periampullary neoplasms

BACKGROUND: The purpose of this study was to determine predictors of surviv al after resection for periampullary neoplasms. METHODS: Over a 15-year period, 208 patients underwent laparotomy for peria mpullary neoplasms. Data were analyzed to assess predictors of survival. RESULTS: Pathologic examination showed pancreatic cancer (n = 136; 65%), am pullary cancer (n = 28; 13%), distal common bile duct cancer (n = 10; 5%), duodenal cancer (n = 4; 2%), neuroendocrine tumor (n = 11; 5%), cystadenoca rcinoma (n = 4; 2%), cystadenoma (n = 5; 2%), and other (n = 10; 5%). A tot al of 129 patients underwent pancreatic resection (71 Whipples, 35 total pa ncreatectomies, 21 distal pancreatectomies, and 2 partial pancreatectomies) whereas 79 patients were found to be unresectable and underwent palliative bypass and/or biopsy. Median survival was 20.4 months for resectable patie nts versus 4.5 months for unresectable patients (P <0.001). Of the 129 rese cted patients, factors significantly (P <0.05) favoring long-term survival on univariate analysis included well-differentiated histology, common bile duct or ampullary adenocarcinoma, early stage, tumor diameter <2 cm, negati ve margins, and absence of lymph node metastases, perineural, or vascular i nvasion. Age, sex, race, and type of procedure had no influence on survival . On multivariate analysis, only tumor differentiation appeared independent ly related to survival. Using Kendall's tau analysis, tumor type and grade correlated significantly with all other predictors. CONCLUSIONS: Of all variables studied, tumor type and poor tumor differenti ation in periampullary neoplasms appear to be markers that predict a conste llation of other adverse findings. (C) 2000 by Excerpta Medica, Inc.