Copyright
©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Jan 27, 2022; 14(1): 24-35
Published online Jan 27, 2022. doi: 10.4240/wjgs.v14.i1.24
Survival after curative pancreaticoduodenectomy for ampullary adenocarcinoma in a South American population: A retrospective cohort study
Ramiro Manuel Fernandez-Placencia, Paola Montenegro, Melvy Guerrero, Mariana Serrano, Emperatriz Ortega, Mercedes Bravo, Lourdes Huanca, Stéphane Bertani, Juan Manuel Trejo, Patricia Webb, Jenny Malca-Vasquez, Luis Taxa, Alberto Lachos-Davila, Juan Celis-Zapata, Carlos Luque-Vasquez, Eduardo Payet, Eloy Ruiz, Francisco Berrospi
Ramiro Manuel Fernandez-Placencia, Juan Celis-Zapata, Eloy Ruiz, Francisco Berrospi, Hepato-Pancreato-Biliary Section, Department of Abdominal Surgery, Instituto Nacional de Enfermedades Neoplasicas, Lima 15038, Peru
Paola Montenegro, Mariana Serrano, Emperatriz Ortega, Department of Medical Oncology, Instituto Nacional de Enfermedades Neoplasicas, Lima 15038, Peru
Melvy Guerrero, Mercedes Bravo, Lourdes Huanca, Patricia Webb, Luis Taxa, Department of Pathology, Instituto Nacional de Enfermedades Neoplasicas, Lima 15038, Peru
Stéphane Bertani, International Joint Laboratory of Molecular Anthopological Oncology, Instituto Nacional de Enfermedades Neoplasicas, Lima 15038, Peru
Stéphane Bertani, Unite Pharmacochim & Pharmacol Dev, UMR152, F-31062 Toulouse, France
Juan Manuel Trejo, Jenny Malca-Vasquez, Alberto Lachos-Davila, Department of Radiation Oncology, Instituto Nacional de Enfermedades Neoplasicas, Lima 15038, Peru
Carlos Luque-Vasquez, Eduardo Payet, Department of Abdominal Surgery, Instituto Nacional de Enfermedades Neoplasicas, Lima 15038, Peru
Author contributions: Fernandez-Placencia RM was the guarantor and designer of the study and carried out data acquisition, statistical analysis and interpretation, and drafting of the initial manuscript; Montenegro P, Serrano M and Ortega E participated in the acquisition, analysis and interpretation of the data and contributed to the initial draft of the manuscript; Guerrero M and Bravo M participated in the pathological reevaluation and contributed intellectual content; Bertani S participated in the design, data analysis and drafting of the initial manuscript; Huanca L, Trejo JM, Webb P, Taxa L, Lachos-Davila A, Celis-Zapata J, Luque-Vasquez C, Payet E and Ruiz E participated in the data analysis and contributed to the critical review of the manuscript along with important intellectual content; Berrospi F mentored, designed and critically revised the article for relevant intellectual content.
Institutional review board statement: Our institutional review board approved this study (Protocol Number 21-17), according to the Declaration of Helsinki19.
Informed consent statement: Informed consent was waived by the IRB (IRB No. 21-17).
Conflict-of-interest statement: No conflicts of interest to be declared.
Data sharing statement: According to the institutional policy, no data from our patients would be shared.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
http://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Ramiro Manuel Fernandez-Placencia, MD, FACS. Surgical Oncologist, Hepato-Pancreato-Biliary Section, Department of Abdominal Surgery, Instituto Nacional de Enfermedades Neoplasicas, 2520 E Angamos Ave. Office 216 Surquillo, Lima 15038, Peru. ramirofp02@gmail.com
Received: May 10, 2021
Peer-review started: May 10, 2021
First decision: August 9, 2021
Revised: September 28, 2021
Accepted: January 13, 2022
Article in press: January 13, 2022
Published online: January 27, 2022
BACKGROUND
Ampullary adenocarcinoma (AAC) is a rare neoplasm that accounts for only 0.2% of all gastrointestinal cancers. Its incidence rate is lower than 6 cases per million people. Different prognostic factors have been described for AAC and are associated with a wide range of survival rates. However, these studies have been exclusively conducted in patients originating from Asian, European, and North American countries.
AIM
To evaluate the histopathologic predictors of overall survival (OS) in South American patients with AAC treated with curative pancreaticoduodenectomy (PD).
METHODS
We analyzed retrospective data from 83 AAC patients who underwent curative (R0) PD at the National Cancer Institute of Peru between January 2010 and October 2020 to identify histopathologic predictors of OS.
RESULTS
Sixty-nine percent of patients had developed intestinal-type AAC (69%), 23% had pancreatobiliary-type AAC, and 8% had other subtypes. Forty-one percent of patients were classified as Stage I, according to the AJCC 8th Edition. Recurrence occurred primarily in the liver (n = 8), peritoneum (n = 4), and lung (n = 4). Statistical analyses indicated that T3 tumour stage [hazard ratio (HR) of 6.4, 95% confidence interval (CI) of 2.5-16.3, P < 0.001], lymph node metastasis (HR: 4.5, 95%CI: 1.8-11.3, P = 0.001), and pancreatobiliary type (HR: 2.7, 95%CI: 1.2-6.2, P = 0.025) were independent predictors of OS.
CONCLUSION
Extended tumour stage (T3), pancreatobiliary type, and positive lymph node metastasis represent independent predictors of a lower OS rate in South American AAC patients who underwent curative PD.
Core Tip: The pancreatobiliary type of ampullary adenocarcinoma, lymph node metastasis and T3 tumour stage (AJCC 8th Ed) are risk factors for lower overall survival in a South American population.
