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Impact of Pancreatic Fistula on Recurrence and Long-Term Prognosis of Periampullary Adenocarcinomas After Pancreaticoduodenectomy
Dowan Kim*, Pablo E. Serrano, Peter T. Kim, Paul D. Greig, Carol-Anne Moulton, Steven Gallinger, Alice C. Wei, Sean Cleary
University of Toronto, Toronto, ON, Canada
Background:
The impact of pancreatic fistulas (PF) on cancer-specific survival and recurrence patterns is not well understood. The objective of this study was to evaluate the impact of PF on disease-free-survival (DFS) and overall-survival (OS) after pancreaticoduodenectomy in patients with periampullary adenocarcinomas, including pancreatic, distal bile duct, duodenal and ampullary adenocarcinoma,
Methods:
This is a retrospective cohort study of patients undergoing pancreaticoduodenectomy for periampullary adenocarcinomas from 2000-2012. Univariate and multivariate survival analyses were performed to determine the impact of PF on DFS and OS, while controlling for pathologic and clinical factors.
Results:
There were 634 PD (pancreas: 347 - other periampullary: 287); median age: 65 (range: 24-84) years; 424/634, 68% had node positive disease; 61/634, 10% had positive margins and 98/634, 16% were poorly differentiated. There were 81/634, 13% patients with PF. Perioperative mortality rate was 1.7% (11/634), higher in patients with PF (10 vs. 0.5%, P < 0.001). In the multivariate analysis, PF significantly reduced DFS [Hazard ratio (HR): 1.6, 95% confidence-interval (CI): 1.1-2.6] in pancreatic but not in other periampullary cancer patients. Other factors associated with decreased DFS and OS were: node, margin-positive, and higher-grade cancers. Adjuvant therapy was associated with improved OS in pancreatic cancer patients (HR: 0.7, 95% CI=0.5-0.9, P=0.02). PF was not associated with decreased OS in pancreatic or other periampullary cancer patients.
Conclusion:
PF increase the risk of pancreas cancer recurrence after pancreaticoduodenectomy. Low tumor grade, negative lymph nodes, and negative resection margin are associated with improved DFS and OS.
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