Predictors of actual five-year survival and recurrence after pancreatoduodenectomy for ampullary adenocarcinoma: results from an international multicentre retrospective cohort study.
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Russell Thomas B, Labib Peter L, Denson Jemimah, Ausania Fabio, Pando Elizabeth, Roberts Keith J, Kausar Ambareen, Mavroeidis Vasileios K, Marangoni Gabriele, Thomasset Sarah C, Frampton Adam E, Lykoudis Pavlos, Maglione Manuel, Alhaboob Nassir, Bari Hassaan, Smith Andrew M, Spalding Duncan, Srinivasan Parthi, Davidson Brian R, Bhogal Ricky H, Croagh Daniel, Dominguez Ismael, Thakkar Rohan, Gomez Dhanny, Silva Michael A, Lapolla Pierfrancesco, Mingoli Andrea, Porcu Alberto, Shah Nehal S, Hamady Zaed Z R, Al-Sarrieh Bilal, Serrablo Alejandro, Aroori Somaiah, RAW Study Collaborators
Аннотация
METHODS: Data were extracted from the Recurrence After Whipple's (RAW) study, a multicentre retrospective study of PD patients with a confirmed head of pancreas or periampullary malignancy (June 1st, 2012-May 31st, 2015). Patients with AA who developed recurrence/died within five-years were compared to those who did not.
RESULTS: 394 patients were included and actual five-year survival was 54%. Recurrence affected 45% and the median time-to-recurrence was 14 months. Local only, local and distant, and distant only recurrence affected 34, 41 and 94 patients, respectively (site unknown: 7). Among those with recurrence, the most common sites were the liver (32%), local lymph nodes (14%) and lung/pleura (13%). Following multivariable tests, number of resected nodes, histological T stage > II, lymphatic invasion, perineural invasion (PNI), peripancreatic fat invasion (PPFI) and ≥1 positive resection margin correlated with increased recurrence and reduced survival. Furthermore, ≥1 positive margin, PPFI and PNI were all associated with reduced time-to-recurrence.
CONCLUSIONS: This multicentre retrospective study of PD outcomes identified numerous histopathological predictors of AA recurrence. Patients with these high-risk features might benefit from adjuvant therapy.