A comprehensive clinicopathological analysis and survival outcome of periampullary cancer following pancreatoduodenectomy

Background: The study was to elucidate the relationships between 20 clinicopathologic factors and survival of patients with periampullary cancer receiving pancreatoduodenectomy (PD) or pylorus-preserving partial pancreatoduodenectomy (PPPD). Methods: The retrospective study recruited 224 patients with periampullary cancer, including duodenal papilla, bile duct and ampullary cancers between January 2000 and August 2010. Twenty clinicopathological variables were considered for univariate and multivariate analysis to identify significant predictive factors of survival. Results: Overall survival rates at 3 and 5 years were 52% and 47%, respectively. Preoperative jaundice, preoperative CA199, lymph node metastasis, site of origin, differentiation, size of tumor, depth of infiltration, pancreatic invasion, peripancreatic soft tissue invasion, UICC pT factor, lymphovascular invasion, and stage (UICC) significantly predicted survival on univariate analysis. PPPD was a marginal significant factor (P = 0.063) for better survival. CA19-9 level, lymph node metastasis, histologic differentiation, size of tumor and UICC pT factor were independent predictors of survival on multivariate analysis. Conclusions: CA19-9, lymph node metastasis, histologic differentiation, size of tumor and UICC pT factor were independent prognostic factors. Biological behavior may be an important prognostic indicator in periampullary cancers amenable to resection, regardless of origin site. Pylorus preservation, not extended pancreatoduodenectomy has marginal benefit for survival.