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Contemporary Surgical, Oncological, and Survival Outcomes of Pancreaticoduodenectomy for Periampullary Tumours: a 5-Year Experience from Tertiary Cancer Center

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Abstract

With advances in surgical management of pancreaticoduodenectomy (PD), mortality rate for PD has been reported to be less than 5%. Postoperative pancreatic fistula (POPF) remains a major complication and morbidity after PD with incidence of up to 40%. This is a retrospective analysis of patients who underwent PD in a tertiary cancer referral center in southern India. Data was collected for the patients operated during the period from Jan 2014 to Dec 2018. Surgicopathological, oncological, and survival outcomes were described. Of 76 patients presumed as operable, 16 were excluded and data analyzed for 60 patients. Forty-four percent underwent classical Whipple’s PD and 56% pylorus-preserving PD. The most common postoperative complications were wound infection (25%); pneumonia (20%); clinically relevant POPF (13%); and delayed gastric emptying (19%). Thirty-day in-hospital mortality was 5%, 90-day mortality was 8.3%, and fistula-related mortality was 1.6%. Ampullary cancer was the most common histology. Three-year survival rate was 23.3% with a mean overall survival of 33.2 months with significantly better survival in the node negative than positive group (41.3 vs 20.5 months, P = 0.003) and significantly lower survival in pancreatic head cancer than other tumor histologies (16.6 vs 37.3 months, P = 0.002). Multivariate analysis has shown pancreatic head histology (HR = 2.38, 95% CI (1.08–5.26), P = 0.033) and nodal positivity (HR = 2.38, 95% CI (1.27–4.44), P = 0.007) as poor prognostic factors. Pancreaticoduodenectomy is a safe operation in experienced hands. Adhering to a meticulous adaptable reproducible anastomotic technique with standard perioperative management strategies significantly decreases the operative morbidity and mortality.

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Acknowledgements

We would like to thank all the residents of surgical oncology and anesthesia for making this publication possible.

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Authors and Affiliations

  1. Department of Surgical Oncology, Kidwai Memorial Institute of Oncology, Dr. M. H. Marigowda Road, Bengaluru, 560029, India

    Ravi Arjunan, S.D.S. Karthik, Ramachandra Chowdappa, Syed Althaf & Chunduri Srinivas

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  1. Ravi Arjunan
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  2. S.D.S. Karthik
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All authors had contributed on the conception and design, data acquisition and analysis, data interpretation, preparation of the manuscript, and its final approval.

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Correspondence to S.D.S. Karthik.

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Ethics Approval

This study was conducted retrospectively from data obtained in course of common clinical practice in the treatment of cancers. We consulted extensively with the institutional review board of Kidwai Memorial Institute of Oncology, who determined that our study did not need ethical approval. The study protocol conforms to the ethical guidelines of the World Medical Association Declaration of Helsinki: Ethical Principles for Medical Research Involving Human Subjects adopted by the 18th WMA General Assembly, Helsinki, Finland, June 1964, as revised in Fortaleza, Brazil, October 2013, and written informed consent was obtained from all patients before the proposed treatment and surgery.

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All patients had consented for the proposed surgery and were explained about the nature of the disease, treatment options, outcomes, and need for regular follow-up.

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Arjunan, R., Karthik, S., Chowdappa, R. et al. Contemporary Surgical, Oncological, and Survival Outcomes of Pancreaticoduodenectomy for Periampullary Tumours: a 5-Year Experience from Tertiary Cancer Center. Indian J Surg Oncol 12, 603–610 (2021). https://doi.org/10.1007/s13193-021-01385-7

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