2564 resected periampullary adenocarcinomas at a single institution: trends over three decades. Issue 1 (8th March 2013)

• Record Type: Journal Article
• Authors: He, Jin; Ahuja, Nita; Makary, Martin A.; Cameron, John L.; Eckhauser, Frederic E.; Choti, Michael A.; Hruban, Ralph H.; Pawlik, Timothy M.; Wolfgang, Christopher L.
• Is Part Of: HPB. Volume 16:Issue 1(2014:Jan.)
• Page Start: 83
• Page End: 90
• Publication Date: 2013-03-08
• Subjects: Liver -- Diseases -- Periodicals; Biliary tract -- Diseases -- Periodicals; Pancreas -- Diseases -- Periodicals; 616.362005
• DOI: 10.1111/hpb.12078
• Languages: English
• ISSNs: 1365-182X

Abstract

<abstract abstract-type="main"> <title>Abstract</title> <sec id="hpb12078-sec-0001" sec-type="section"> <title>Objective</title> <p>This study was carried out to determine relative survival rates and trends in outcomes in patients who underwent resection of periampullary adenocarcinomas (PACs) with curative intent at a single institution over the last three decades.</p> </sec> <sec id="hpb12078-sec-0002" sec-type="section"> <title>Methods</title> <p>From 1980 to 2011, 2564 pancreaticoduodenectomies (PDs) were performed for PACs. Pathological diagnosis, therapy and survival were retrospectively analysed.</p> </sec> <sec id="hpb12078-sec-0003" sec-type="section"> <title>Results</title> <p>The primary sites included the pancreas (66%), ampulla (16%), bile duct (12%) and duodenum (6%). Operation volume increased from 11 per year in the 1980s to 135 per year in the 2000s (<italic>P</italic> < 0.001). Patients in the 1980s were younger (median age: 64 years; range: 33–90 years) than those in the 1990s (median age: 68 years; range: 31–103 years) and 2000s (median age: 68 years; range: 24–93 years) (<italic>P</italic> < 0.001). Over time, the frequency of a diagnosis of pancreatic cancer arising from intraductal papillary mucinous neoplasm increased from 2% in the 1980s to 8% in the 2000s (<italic>P</italic> < 0.001). The rate of 30‐day mortality after surgery in the 1980s was 2%, which was similar to rates in the 1990s (1%) and 2000s (1%). Survival in each type of PAC did not change over time. Pancreatic cancer was associated with the worst survival (median survival: 19 months) compared with adenocarcinomas of the ampulla (median survival: 47 months), bile duct (median survival: 23 months) and duodenum (median survival: 54 months) (<italic>P</italic> < 0.001).</p> </sec> <sec id="hpb12078-sec-0004" sec-type="section"> <title>Conclusions</title> <p>There are significant differences among PACs in longterm survival following PD. Although the numbers of patients undergoing safe resection have increased, overall longterm outcomes have not improved significantly.</p> </sec> </abstract>