Survival after pancreaticoduodenectomy for periampullary adenocarcinoma: an update

Aim: Survival after pancreaticoduodenectomy for periampullary tumours is li mited. Over the last decade perioperative management has improved and morbi dity and mortality decreased. The aim of the study was to analyse recent su rvival data after pancreaticoduodenectomy and to determine factors that inf luence survival. Methods: From October 1992 to September 1998, 204 patients with a ductal ad enocarcinoma in the pancreatic head (108), distal bile duct (32), and ampul la (64) who underwent standard pancreaticoduodenectomy, were analysed with regard to histology and tumour status. Survival was calculated by using the Kaplan-Meier method. Risk factors were identified in a univariate and mult ivariate analysis. Results: Median survival after resection for carcinoma of the pancreatic he ad, distal bile duct, and ampulla were 16*, 25 and 24* months, respectively (*P=0.008). In the univariate analysis vein resection, blood transfusion o f more than four packed red cells, the presence of tumour positive resectio n margins, lymph-node metastases and poor tumour differentiation significan tly decreased survival. In the multivariate analysis positive resection mar gins, lymph-node metastases, and poor tumour differentiation independently influenced survival. Conclusions: Resection margins, lymph-node status and tumour differentiatio n are independent prognostic factors. Survival after standard pancreaticodu odenectomy for periampullary tumours has not improved. (C) 2001 Harcourt Pu blishers Ltd.