Fernandez-Placencia RM, Montenegro P, Guerrero M, Serrano M, Ortega E, Bravo M, Huanca L, Bertani S, Trejo JM, Webb P, Malca-Vasquez J, Taxa L, Lachos-Davila A, Celis-Zapata J, Luque-Vasquez C, Payet E, Ruiz E, Berrospi F. Survival after curative pancreaticoduodenectomy for ampullary adenocarcinoma in a South American population: A retrospective cohort study. World J Gastrointest Surg 2022; 14(1): 24-35 [PMID: 35126860 DOI: 10.4240/wjgs.v14.i1.24]
Corresponding Author of This Article
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
Research Domain of This Article
Oncology
Article-Type of This Article
Retrospective Cohort Study
Open-Access Policy of This Article
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Clinical, laboratory and operative patient characteristics (n = 83)
Age (yr), median (IQR)
59 (49–67)
Sex, male/female, n (%)
36 (43)/47 (57)
Perioperative transfusion, n (%)
21 (25)
Haemoglobin in g/L, median (IQR)
115 (108–127)
Platelet count in 109/L, median (IQR)
285 (243–372)
International Normalized Ratio, median (IQR)
1.06 (1.01–1.15)
Serum glucose in mmol/L, median (IQR)
5.1 (4.8–5.7)
Serum creatinine in mmol/L, median (IQR)
53 (47–65)
Serum albumin in g/L, median (IQR)
38.1 (32–41.1)
Serum total bilirubin in µmol/L, median (IQR)
23.9 (12.9–60)
Serum CA 19-9 in IU/mL, median (IQR)
26.3 (10–91.4)
Pancreaticoduodenectomy
Pylorus-preserving PD, n (%)
69 (83)
Whipple procedure, n (%)
14 (17)
Table 2 Histopathologic characteristics (n = 83)
Histopathologic characteristics (n = 83)
Tumour size in mm, median (IQR)
27 (17–40)
Subtype, n (%)
Intestinal
57 (69)
Pancreatobiliary
19 (23)
Others
7 (8)
Tumour status, n (%)
T1
7 (8)
T2
44 (53)
T3
32 (39)
Number of lymph nodes assessed, median (IQR)
17 (12–24)
Lymph node status, n (%)
N0
50 (60)
N1
22 (26)
N2
11 (14)
Differentiation, n (%)
Well differentiated
25 (30)
Moderately differentiated
53 (64)
Poorly differentiated
5 (6)
Lymphovascular invasion
30 (36)
Perineural invasion
26 (31)
Table 3 Recurrence patterns after pancreaticoduodenectomy (n = 19)
Organs involved
Distant metastasis, n (%)
(A) First organ
(B) Second organ
(C) Third organ
A + B + C
%
Liver
8
3
1
12
32
Peritoneum
4
3
1
8
22
Lung
4
2
1
7
19
Supraclavicular lymph node
1
1
3
Bone
1
1
3
Suprarenal gland
1
1
3
Sub-table total
30
81
Lymph nodal recurrence, n (%)
Celiac trunk
1
1
3
Hepatic hilum
1
1
3
Mesenteric lymph nodes
1
1
2
5
Retroperitoneal lymph nodes
2
1
3
8
Sub-table total
7
19
Total
37
100
Table 4 Cox regression model analysis for predictors of overall survival
Variables
Hazard ratio
95%CI
P value
Lower
Upper
Age in yr
0.355
Tumour size in mm
1.03
1
1.06
0.059
Histopathologic subtype
Intestinal/other types
Pancreatobiliary type
2.7
1.2
6.2
0.025
T classification
T1-T2
T3
6.4
2.5
16.3
< 0.001
Lymph node metastasis
No
Yes
4.5
1.8
11.3
0.001
Differentiation grade
0.54
Well differentiated
Moderately differentiated
0.268
Poorly differentiated
0.755
Perineural invasion
0.517
Lymphovascular invasion
0.26
Citation: Fernandez-Placencia RM, Montenegro P, Guerrero M, Serrano M, Ortega E, Bravo M, Huanca L, Bertani S, Trejo JM, Webb P, Malca-Vasquez J, Taxa L, Lachos-Davila A, Celis-Zapata J, Luque-Vasquez C, Payet E, Ruiz E, Berrospi F. Survival after curative pancreaticoduodenectomy for ampullary adenocarcinoma in a South American population: A retrospective cohort study. World J Gastrointest Surg 2022; 14(1): 24-35