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Predictors of actual five-year survival and recurrence after pancreatoduodenectomy for ampullary adenocarcinoma: results from an international multicentre retrospective cohort study

医学 回顾性队列研究 切除缘 淋巴血管侵犯 旁侵犯 恶性肿瘤 胰十二指肠切除术 腺癌 内科学 胃肠病学 外科 比例危险模型 辅助治疗 胰腺 癌症 切除术 转移
作者
Thomas Russell,Peter Labib,Jemimah Denson,Fabio Ausania,Elizabeth Pando,Keith Roberts,Ambareen Kausar,Vasileios Mavroeidis,Gabriele Marangoni,Sarah C. Thomasset,Adam E. Frampton,Pavlos Lykoudis,Manuel Maglione,Nassir Alhaboob,Hassaan Bari,Andrew M. Smith,Duncan Spalding,Parthi Srinivasan,Brian R Davidson,Ricky H. Bhogal,Daniel Croagh,Ismael Domínguez,Rohan Thakkar,Dhanny Gomez,Michael A. Silva,Pierfrancesco Lapolla,Andrea Mingoli,Alberto Porcu,Nehal Shah,Zaed Hamady,Bilal Al-Sarireh,Alejandro Serrablo,Somaiah Aroori,Somaiah Aroori,Peter Labib,Thomas Russell,Adam Streeter,Jemimah Denson,Mark Puckett,Matthew G. Browning,Fabio Ausania,Carolina González‐Abós,Elizabeth Pando,Nair Fernandes,Elsa Garcia Moller,Cristina Dopazo Taboada,Keith Roberts,Rupaly Pandé,Jameel Alfarah,Ambareen Kausar,Samik Bandyopadhyay,Ahmed Abdel-Rahim,Ayesha Khan,Vasileios Mavroeidis,Caitlin Jordan,Jonathan Rees,Gabriele Marangoni,Collaborator Harry Blege,Sarah C. Thomasset,William Cambridge,Olga White,Adam E. Frampton,Sarah Blacker,Jessie Blackburn,Casie Sweeney,Pavlos Lykoudis,Daniel J. Field,Mohammed K. Gouda,Manuel Maglione,Ruben Bellotti,Nassir Alhaboob,Hytham K. S. Hamid,Hassaan Bari,Hassan Ahmed,Andrew M. Smith,Catherine Moriarty,Louise G. White,Mark Priestley,Kerry Bode,J. A. Sharp,Rosie Wragg,Beverley Jackson,Samuel Craven,Duncan Spalding,Matyas Fehervari,Madhava Pai,Laith Alghazawi,Anjola Onifade,Parthi Srinivasan,Julliette Ribaud,Ashitha Nair,Michael Mariathasan,Niamh Grayson,Brian R Davidson,Stephanos Pericleous,Krishna Patel,Conrad Shaw,Nolitha Morare,Mohamad K. Zaban,Ricky H. Bhogal,Joseph Doyle,Vasileios Mavroeidis,Daniel Croagh,Ismael Domínguez,Alan Guerrero,Andre Moguel,Carlos H.F. Chan,Rohan Thakkar,Michael Jones,Edward G. Buckley,Nasreen Akter,Kyle Treherne,Dhanny Gomez,Gregory S. Gordon,Michael A. Silva,Daniel Hughes,Tomas Urbonas,Pierfrancesco Lapolla,Andrea Mingoli,Gioia Brachini,Roberto Caronna,Piero Chirletti,Alberto Porcu,Teresa Perra,Nehal Shah,Nurul Nadhirah Abd Kahar,Thomas Hall,Nabeegh Nadeem,Zaed Hamady,Shoura Karar,Ali Arshad,Bilal Al-Sarireh,Adam Yarwood,Mohammed Hammoda,Alejandro Serrablo,María Soler Artigas,Sandra Paterna-LÃ pez
出处
期刊:Hpb [Elsevier]
卷期号:25 (7): 788-797 被引量:2
标识
DOI:10.1016/j.hpb.2023.03.010
摘要

Pancreatoduodenectomy (PD) is recommended in fit patients with a resectable ampullary adenocarcinoma (AA). We aimed to identify predictors of five-year recurrence/survival.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.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.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.
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