Factors predicting survival after pancreaticoduodenectomy for periampullary carcinoma - A Retrospective analysis.

INTRODUCTION : Carcinoma of periampullary region accounts for 85% of pancreaticoduodenectomies at our institute. Tumours of ampulla of vater are relatively rare, with an crude incidence rate of 0.53 /1,00,000 population per year. Overall periampullary cancers account for 5 % of all gastrointestinal tract malignancies. A periampullary carcinoma – one arising in the region of ampulla of vater , may be from one of four potential origins- pancreas ,bile duct, the ampulla itself or periampullary duodenum. Surgical series of periampullary tumors have demonstrated that patients with ampullary tumors have a more favourable prognosis than those with pancreatic or bile duct tumors with median survivals of 30 to 50 months and 5-year survival rates between 30% and 50%. Lymph node metastasis and vascular invasion were found to be independent factors adversely influencing survival in an Indian study. Studies attempting to determine important factors affecting survival have been limited by several factors..Most contain small numbers of patients collected over many decades & many do not use multivariate analysis to identify independent prognostic factors. Furthermore , most studies do not assess preoperative factors such as age or biochemical variables. AIMS & OBJECTIVES : 1. To analyse factors influencing survival in a series of patients with periampullary tumours who underwent pancreaticoduodenectomy in a single tertiary referral unit . 2. To examine the results of resection & its impact on clinical outcomes on various typesof carcinomas including Ampullary carcinoma,distal Cholangiocarcinoma & Duodenal Carcinoma. MATERIALS AND METHODS : Pooled data from patients undergoing pancreaticoduodenectomy for periampullary carcinoma over a 13 year period from 1995 to 2008 was retrospectively evaluated and analysed. Included in this study were 69 consecutive cases of nonpancreatic periampullary carcinomas ,which during final histological examination proved to be ampullary, cholangial or duodenal origin. All patients had adenocarcinoma of periampullary region. All patients underwent evaluation and treatment at our institute between 1995 to 2008. Patients with benign pathologies, neuroendocrine tumours and carcinoma of head of pancreas who underwent pancreaticoduodenectomy were excluded from this study. All patients underwent thorough clinical examination. Routine hemogram, renal function test, liver function test, chest x ray, electrocardiogram were done for all patients. USG Abdomen & pelvis ,CT abdomen & pelvis were done as part of staging evaluation. ERCP and stenting were done in selected patients either done outside or at our institute. CONCLUSION : Preoperative bilirubin , nodal involvement and Lymphovascular invasion are important predictors of survival in those who undergo resection of non pancreatic periampullary carcinoma. Ampullary tumours have a good prognosis, as they are often resectable .The acceptable morbidity rate among resected patients , support an aggressive surgical approach to the management of ampullary tumours