✦ LIBER ✦

Prognostic factors for survival after pancreaticoduodenectomy for patients with carcinoma of the pancreatic head region

✍ Scribed by J. Hein Allema; Marcel E. Reinders; Thomas M. van Gulik; Mark J. W. Koelemay; Dirk J. van Leeuwen; Laurens Th. de Wit; Dirk J. Gouma; Huug Obertop

Publisher: John Wiley and Sons
Year: 1995
Tongue: English
Weight: 648 KB
Volume: 75
Category: Article
ISSN: 0008-543X
DOI: 10.1002/1097-0142(19950415)75:8<2069::aid-cncr2820750807>3.0.co;2-7

No coin nor oath required. For personal study only.

✦ Synopsis

Background. The aim of this study was to determine prognostic factors for survival after pancreaticoduodenectomy (PD) for carcinoma of the pancreatic head region.

Methods. From 1983 to 1992.176 patients underwent PD for ampullary carcinoma (n = 67), distal bile duct carcinoma (n = 42), or pancreatic carcinoma (n = 67). The first choice for resection was subtotal PD (n = 146), but patients with a tumor-positive pancreatic margin or a brittle pancreatic duct underwent total PD (n = 30).

Results. Hospital mortality was 4.7% after subtotal PD and 20% after total PD. Overall 5-year survival was 31%. Survival after PD for ampullary carcinoma care. (5year, 50%) was significantly better (P < 0.001) than for distal bile duct carcinoma (24%) and pancreatic carcinoma (14%). Independent negative prognostic factors for survival (multivariate analysis) were involved resection margins (hazard rate ratio [HRR] 4.08), major vascular involvement (HRR 2.20), distal bile duct or pancreatic origin of carcinoma (HRR 1.93), and perioperative blood transfusion of more than 4 U (HRR 1.76). Tumor size (>2 cm), regional lymph node involvement, and a poor differentiation grade were overall negative factors in univariate analysis but not in the subgroup of ampullary carcinoma.

Conclusion. Involvement of resection margins, major vascular ingrowth, site of origin of carcinoma, and perioperative blood transfusion were independent prognostic factors for survival after PD. Overall 5-year survival was 31%, and subtotal PD is advocated for all patients with a macroscopically resectable tumor in the pancreatic head From the

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