Ann Hepatobiliary Pancreat Surg.  2023 Feb;27(1):76-86. 10.14701/ahbps.22-039.

Five-year follow-up after pancreatoduodenectomy performed for malignancy: A single-centre study

• Russell TB
• Labib PLZ
• Aroori S

• KMID: 2539517
• DOI: http://doi.org/10.14701/ahbps.22-039

Abstract

Backgrounds/Aims
The aim of this study was to describe short- and long-term outcomes of patients who underwent pancreatoduodenectomy (PD) at a typical United Kingdom hepatopancreatobiliary unit.
Methods
A retrospective analysis of all PD patients with histologically-confirmed pancreatic ductal adenocarcinoma (PDAC), ampullary adenocarcinoma (AA), or distal cholangiocarcinoma (CC) from September 1st, 2006 to May 31st, 2015 was carried out. The following information was obtained: demographics, comorbidities, preoperative investigations, neoadjuvant treatment, operative details, postoperative management, complications, adjuvant treatment, five-year recurrence, and five-year survival. Effects of selected preoperative variables on short- and long-term outcomes were investigated.
Results
Of 271 included patients, 57.9% had PDAC, 25.8% had AA, and 16.2% had CC. In total, 67.9% experienced morbidity and 17.3% developed a Clavien-Dindo grade ≥ III complication. The 90-day mortality was 3.3%. Clinically-relevant postoperative pancreatic fistula, bile leak, gastrojejunal leak, postpancreatectomy haemorrhage and delayed gastric emptying affected 8.1%, 4.1%, 0.0%, 9.2%, and 19.9% of patients, respectively. American Society of Anesthesiologists grade III–VI correlated with overall morbidity (p = 0.002) and major morbidity (p = 0.009), but not 90-day mortality or five-year survival. The same pattern was observed in patients with a preoperative serum bilirubin > 29 µmol/L and/or a neutrophil/lymphocyte ratio > 3.1. Five-year cancer recurrence and five-year survival were 68.3% and 22.5%, respectively. PDAC patients had higher five-year recurrence but lower five-year survival rates (both p = 0.001).
Conclusions
In our series, the majority of patients experienced a complication. However, few patients experienced major morbidity. Surgical risk factors did not affect five-year survival.

Keyword

Pancreaticoduodenectomy; Pancreatic ductal carcinoma; Morbidity; Mortality; Survival

Figure

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  Fig. 1 Flow diagram showing the selection of the study cohort. PD, pancreatoduodenectomy; PDAC, pancreatic ductal adenocarcinoma; AA, ampullary adenocarcinoma; CC, cholangiocarcinoma.

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  Fig. 2 (A) Survival curves by histology. (B) Time-to-recurrence curves by histology. PDAC, pancreatic ductal adenocarcinoma; AA, ampullary adenocarcinoma; CC, cholangiocarcinoma.

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