Peripancreatic Fat Invasion Is An Independent Predictor of Poor Outcome Following Pancreaticoduodenectomy for Pancreatic Ductal Adenocarcinoma and Influences the Pattern of Recurrence
Nigel B. Jamieson*1, Karin Oien2, Alan K. Foulis2, Euan J. Dickson1, Clem W. Imrie1, Ross Carter1, Colin Mckay1
1West of Scotland Pancreatic Unit, Glasgow University Department of Surgery, Glasgow Royal Infirmary, Glasgow, United Kingdom; 2Glasgow University Department of Pathology, Glasgow Royal Infirmary, Glasgow, United Kingdom
BackgroundFollowing pancreaticoduodenectomy for pancreatic ductal adenocarcinoma (PDAC), evidence of peripancreatic fat invasion at pathological staging promotes a tumour to a higher T stage. In a cohort of PDAC we sought identify the influence of peripancreatic fat invasion on survival and the pattern of recurrence following pancreaticoduodenectomy.MethodsWe analysed the patient demographics, outcome and recurrence data in 188 consecutive PDAC undergoing potentially curative pancreaticoduodenectomy between 1996 to 2008. Pathological features were reassessed for all patients. Survival outcome was compared using Kaplar-Meier/Cox proportional hazards analysis.ResultsThe median survival of the PDAC cohort was 19.9months (95%CI:17.2-23.4). 49(26%) patients had evidence of peripancreatic fat invasion. Survival was negatively influenced by high histological tumour grade, vascular invasion, greater tumour stage, lymph node metastasis, larger tumour size, resection margin involvement (all P < 0.01) and peripancreatic fat invasion which resulted in a median survival time of 11.9months (95%CI:9.4-14.7) vs 24.4months (95%CI:19.3-25.6)(p=0.001) for patients with no evidence of fat invasion. In the multivariate model outcome prediction was achieved by vascular invasion tumour grade, resection margin status and peripancreatic fat invasion (Hazard ratio=2.1 (95%CI: 1.4-3.2); p=0.001). The presence of peripancreatic fat invasion did not correlate with other clinicopathological features however peripancreatic fat invasion and was the only variable significantly associated with local recurrence being the primary site of failure following pancreaticoduodenectomy (p<0.01)ConclusionsPeripancreatic fat invasion was identified as a predictor of poor outcome following pancreaticoduodenectomy for PDAC, independent of T stage, UICC stage, lymph node status and resection margin positvity. Invasion of the peripancreatic fat was also strongly associated with local recurrence being the principal site of tumour recurrence. Rigorous pathological assessment seeking tumour invasion of the peripancreatic fat can identify a subgroup of patients who may benefit from more aggressive adjuvant therapies.
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