TY - JOUR
T1 - Predictors of actual five-year survival and recurrence after pancreatoduodenectomy for ampullary adenocarcinoma
T2 - results from an international multicentre retrospective cohort study
AU - Russell, Thomas B.
AU - Labib, Peter L.
AU - Denson, Jemimah
AU - Ausania, Fabio
AU - Pando, Elizabeth
AU - Roberts, Keith J.
AU - Kausar, Ambareen
AU - Mavroeidis, Vasileios K.
AU - Marangoni, Gabriele
AU - Thomasset, Sarah C.
AU - Frampton, Adam E.
AU - Lykoudis, Pavlos
AU - Maglione, Manuel
AU - Alhaboob, Nassir
AU - Bari, Hassaan
AU - Smith, Andrew M.
AU - Spalding, Duncan
AU - Srinivasan, Parthi
AU - Davidson, Brian R.
AU - Bhogal, Ricky H.
AU - Croagh, Daniel
AU - Dominguez, Ismael
AU - Thakkar, Rohan
AU - Gomez, Dhanny
AU - Silva, Michael A.
AU - Lapolla, Pierfrancesco
AU - Mingoli, Andrea
AU - Porcu, Alberto
AU - Shah, Nehal S.
AU - Hamady, Zaed Z.R.
AU - Al-Sarrieh, Bilal
AU - Serrablo, Alejandro
AU - Aroori, Somaiah
AU - Streeter, Adam
AU - Puckett, Mark
AU - Browning, Matthew G.
AU - arolina Gonzalez-Abos, Gonzalez-Abos
AU - Fernandes, Nair
AU - Moller, Elsa G.
AU - Taboada, Cristina D.
AU - Pande, Rupaly
AU - Alfarah, Jameel
AU - Bandyopadhyay, Samik
AU - Abdelrahim, Ahmed
AU - Khan, Ayesha
AU - Jordan, Caitlin
AU - Rees, Jonathan R.E.
AU - Blege, Collaborator: Harry
AU - Thomasset, Sarah
AU - Cambridge, William
AU - White, Olga
AU - Frampton, Adam
AU - Blacker, Sarah
AU - Blackburn, Jessie
AU - Sweeney, Casie
AU - Field, Daniel
AU - Gouda, Mohammed
AU - Bellotti, Ruben
AU - Hamid, Hytham K.S.
AU - Ahmed, Hassan
AU - Smith, Andrew
AU - Moriarty, Catherine
AU - White, Louise
AU - Priestley, Mark
AU - Bode, Kerry
AU - Sharp, Judith
AU - Wragg, Rosie
AU - Jackson, Beverley
AU - Craven, Samuel
AU - Fehervari, Matyas
AU - Pai, Madhava
AU - Alghazawi, Laith
AU - Onifade, Anjola
AU - Ribaud, Julliette
AU - Nair, Ashitha
AU - Mariathasan, Michael
AU - Grayson, Niamh
AU - Davidson, Brian
AU - Pericleous, Stephanos
AU - Krishna Patel, Patel
AU - Shaw, Conrad
AU - Morare, Nolitha
AU - Zaban, Mohamad K.
AU - Bhogal, Ricky
AU - Doyle, Joseph
AU - Guerrero, Alan
AU - Moguel, Andre
AU - Chan, Carlos
AU - Jones, Michael
AU - Buckley, Edward
AU - Akter, Nasreen
AU - Treherne, Kyle
AU - Gordon, Gregory
AU - Hughes, Daniel
AU - Urbonas, Tomas
AU - Brachini, Gioia
AU - Caronna, Roberto
AU - Chirletti, Piero
AU - Perra, Teresa
AU - Abd Kahar, Nurul N.
AU - Hall, Thomas
AU - Nadeem, Nabeegh
AU - Hamady, Zaed
AU - Karar, Shoura
AU - Arshad, Ali
AU - Yarwood, Adam
AU - Hammoda, Mohammed
AU - Artigas, Maria
AU - Paterna-López, Sandra
AU - RAW Study Collaborators
N1 - Funding Information:
We would like to thank all those who contributed to the Recurrence After Whipple's (RAW) study. We would also like to thank Dr Adam Streeter for advising on the statistical methods.
Publisher Copyright:
© 2023 International Hepato-Pancreato-Biliary Association Inc.
PY - 2023/7
Y1 - 2023/7
N2 - Background: Pancreatoduodenectomy (PD) is recommended in fit patients with a resectable ampullary adenocarcinoma (AA). We aimed to identify predictors of five-year recurrence/survival. Methods: Data were extracted from the Recurrence After Whipple's (RAW) study, a multicentre retrospective study of PD patients with a confirmed head of pancreas or periampullary malignancy (June 1st, 2012–May 31st, 2015). Patients with AA who developed recurrence/died within five-years were compared to those who did not. Results: 394 patients were included and actual five-year survival was 54%. Recurrence affected 45% and the median time-to-recurrence was 14 months. Local only, local and distant, and distant only recurrence affected 34, 41 and 94 patients, respectively (site unknown: 7). Among those with recurrence, the most common sites were the liver (32%), local lymph nodes (14%) and lung/pleura (13%). Following multivariable tests, number of resected nodes, histological T stage > II, lymphatic invasion, perineural invasion (PNI), peripancreatic fat invasion (PPFI) and ≥1 positive resection margin correlated with increased recurrence and reduced survival. Furthermore, ≥1 positive margin, PPFI and PNI were all associated with reduced time-to-recurrence. Conclusions: This multicentre retrospective study of PD outcomes identified numerous histopathological predictors of AA recurrence. Patients with these high-risk features might benefit from adjuvant therapy.
AB - Background: Pancreatoduodenectomy (PD) is recommended in fit patients with a resectable ampullary adenocarcinoma (AA). We aimed to identify predictors of five-year recurrence/survival. Methods: Data were extracted from the Recurrence After Whipple's (RAW) study, a multicentre retrospective study of PD patients with a confirmed head of pancreas or periampullary malignancy (June 1st, 2012–May 31st, 2015). Patients with AA who developed recurrence/died within five-years were compared to those who did not. Results: 394 patients were included and actual five-year survival was 54%. Recurrence affected 45% and the median time-to-recurrence was 14 months. Local only, local and distant, and distant only recurrence affected 34, 41 and 94 patients, respectively (site unknown: 7). Among those with recurrence, the most common sites were the liver (32%), local lymph nodes (14%) and lung/pleura (13%). Following multivariable tests, number of resected nodes, histological T stage > II, lymphatic invasion, perineural invasion (PNI), peripancreatic fat invasion (PPFI) and ≥1 positive resection margin correlated with increased recurrence and reduced survival. Furthermore, ≥1 positive margin, PPFI and PNI were all associated with reduced time-to-recurrence. Conclusions: This multicentre retrospective study of PD outcomes identified numerous histopathological predictors of AA recurrence. Patients with these high-risk features might benefit from adjuvant therapy.
UR - http://www.scopus.com/inward/record.url?scp=85156139433&partnerID=8YFLogxK
U2 - 10.1016/j.hpb.2023.03.010
DO - 10.1016/j.hpb.2023.03.010
M3 - Article
C2 - 37149485
AN - SCOPUS:85156139433
SN - 1365-182X
VL - 25
SP - 788
EP - 797
JO - HPB
JF - HPB
IS - 7
ER -