[Results of pancreaticoduodenectomy in the treatment of periampullary tumors].

BACKGROUND

The diagnosis and treatment of periampullary tumors represents a challenge for current medicine.

AIM

To review the results of pancreaticoduodenectomy (PDD) in the treatment of periampullary tumors and to identify risk factors that impact the long-term survival.

PATIENTS AND METHODS

We performed a retrospective study of patients who underwent a PDD for periampullary tumors between 1993 and 2009. We reviewed perioperative results and long term survival. We performed a multivariate analysis for long-term survival.

RESULTS

A PDD was performed in 181 patients aged 58 ± 12 years (98 females). Pyloric preservation was done in 53% and a pancreatogastric anastomosis was used in 94% of cases. Morbidity was 62% and postoperative mortality was 5.5%. Pancreatic cancer was the most frequent pathological finding in 41%, followed by ampullary cancer in 28% and distal bile duct cancer in 16%. Median survival was 17 months, with a five years survival of 24%. Survival for ampullary tumors was 28 months with a five years survival of 32%. The median and five years survival were 14 months and 16% for bile duct cancer and 11 months and 14% for pancreatic cancer. Multivariate analysis identified tumor type (pancreas /bile duct) and lymph node dissemination as independent predictors of mortality.

CONCLUSIONS

One quarter of patients experienced long term survival. Mortality predictors were tumor type and lymph node dissemination.