Periampullary carcinoma - Factors influencing survival

Background - Pancreaticoduodenectomy is the treatment of choice for periampullary carcinoma, The present study was undertaken to evaluate the influence of histopathological risk factors and the efficacy of postoperative adjuvant therapy on early recurrence and survival. Method - Twenty-nine patients who underwent pancreaticoduodenectomy for periampullary carcinoma and had a minimum follow-up of sis months were included in the study, The degree of differentiation, resection margin involvement, pancreatic infiltration and lymph node metastasis in the resected specimen were evaluated on histopathological review, Adjuvant therapy was administered to 15 patients; it included 40-45 Gy of external radiotherapy (EBRT) and 5-Flurouracil (5-Fu) weekly for 12 cycles. Results - The site of origin was ampullary in 17, bile duct in six, duodenum in four and pancreatic duct in two patients, Fourteen patients had,yell differentiated tumors, Pancreatic infiltration was present in nine patients and eight patients had lymph node metastasis. Follow-up ranged from 7-62 months (median 12 months), Recurrent disease developed in seven patients, The likelihood of recurrence was significantly increased in the presence of pancreatic infiltration (p = 0.001), lymph node metastasis (p = 0.012) and moderate or poor differentiation (p = 0.012) of the tumor, Six patients died during follow-up, Lymph node involvement was found to be the most significant risk factor adversely affecting survival (p = 0.04). Pancreatic infiltration also resulted in poor survival (p = 0.06), whereas the degree of differentiation did not influence survival, There was a significant improvement of survival in 15 patients who received adjuvant therapy (p = 0.038). Conclusion - Pancreatic infiltration and nodal metastasis adversely influence survival and predict early recurrence, Adjuvant therapy with EBRT + weekly 5-Fu improves survival in patients with periampullary cancer.