HPB P63 Five-year follow-up after pancreatoduodenectomy performed for malignancy: a nine-year experience

Abstract Background Pancreatic ductal adenocarcinoma (PDAC) of the pancreatic head is a leading cause cancer-related death in Western world and its incidence set to rise across globe. Unfortunately, majority patients present with metastatic disease prognosis very poor. Ampullary (AA) cholangiocarcinoma (CC) are less common but their prognoses only marginally better. Patients one these cancers may undergo pancreaticoduodenectomy (PD) providing they resectable have an appropriate performance status. Whilst this offers some possibility cure, it high-risk operation overall morbidity often quoted at 50%. Additionally, early recurrence rates high few achieve long-term survival. This study aimed describe experience typical tertiary hepatopancreatobiliary (HPB) unit United Kingdom. We compile complication profile investigate impact selected preoperative variables on short- outcomes. also compare patient outcomes based cancer type. Methods were included if underwent PD for histologically-confirmed PDAC, AA or CC our institution between 01/09/2006 31/05/2015. The end date 31/05/2015 was chosen complete five-year follow-up all patients. Information collected following: demographics, comorbidities, imaging staging, NAT (if given), blood results, procedure intraoperative findings, postoperative management complications, histology adjuvant treatment recurrence, palliative When comparing by histological diagnosis, medians compared using Kruskal-Wallis test other Fisher's exact test. used association morbidity, major (Clavien-Dindo grade I II complications excluded), 90-day mortality five year Kaplan-Meier method survival CC. Mantel-Cox statistical significance. A p-value than 0.05 considered statistically significant. Results total 271 included; 57.9% had diagnosis 25.8% 16.2% Ninety-day 3.3%, 67.9% experienced least 17.3% which Clavien-Dindo III higher. 401 recorded; 27.2% CD I, 53.2% II, 12.7% III, 4.4% IV 1.5% V. Rates CR-POPF, bile leak, gastrojejunal PPH DGE 8.1%, 4.1%, 0.0%, 9.2% 19.9%, respectively. bilirubin ≤29 µmol/L (p=0.03) (p=0.02) did not affect (p=0.7). Similarly, those neutrophil/lymphocyte ratio (NLR) ≤3.1 lower (p=0.04) (p=0.01) difference significant (p=0.3). An ASA correlated increased (p=0.002) (p=0.009) (p=0.2). Overall 22.5%; affected age, BMI, tests. Conclusions In series, most fifth morbidity. III/IV and/or NLR more commonly Five-year 68.3% 22.5%, studied Surgeons who perform should sound understanding figures above as will guide selection consenting process. Future research focus identifying likely poor outcomes, sub-group benefit from neoadjuvant chemotherapy.