Nontraditional criteria for prediction of patient survival following pancreaticoduodenectomy for malignancy

Introduction This study analyzed the histological features modifying the outcome after pancreaticoduodenectomy operation for periampullary tumors. Patients and methods This study is a prospective cohort. A total of 35 cases of pancreaticoduodenectomy operations were performed from March 2011 to February 2013. Of the procedures, 23 cases were diagnosed as pancreatic carcinoma, and the rest were ampullary carcinomas (7), cholangiocarcinomas (3), and duodenal carcinomas (2). Statistical analysis was completed by using log-rank and Cox regression multivariate analyses. Results The 5-year survival rate was 29% for all patients who went through pancreaticoduodenectomy. For periampullary carcinomas other than pancreatic carcinoma, the 1, 3, and 5-year survival rates were 100, 66.7, and 58.3%, respectively. The 1, 3, and 5-year survival rates for pancreatic carcinoma were 42.1, 10.5, and 10.5%, respectively (P=0.01). In the multivariate analysis, the existence of both perineural and lymphovascular invasions were the only independent factors influencing outcome. The 5-year survival rate was 88.9% in patients negative for both factors and 0% in patients positive for both (P=0.02). Conclusion Cases with both perineural and lymphovascular invasions on histopathological analysis have poor 5-year survival outcomes after Whipple’s procedure for pancreatic and periampullary malignant tumors.