title: Prognostic factors for survival after pancreaticoduodenectomy for patients with carcinoma of the pancreatic head region.
abstract: BACKGROUND
  The aim of this study was to determine prognostic factors for survival after pancreaticoduodenectomy (PD) for carcinoma of the pancreatic head region.
  
  
  METHODS
  From 1983 to 1992. 176 patients underwent PD for ampullary carcinoma (n = 67), distal bile duct carcinoma (n = 42), or pancreatic carcinoma (n = 67). The first choice for resection was subtotal PD (n = 146), but patients with a tumor-positive pancreatic margin or a brittle pancreatic duct underwent total PD (n = 30).
  
  
  RESULTS
  Hospital mortality was 4.7% after subtotal PD and 20% after total PD. Overall 5-year survival was 31%. Survival after PD for ampullary carcinoma care. (5-year, 50%) was significantly better (P < 0.001) than for distal bile duct carcinoma (24%) and pancreatic carcinoma (14%). Independent negative prognostic factors for survival (multivariate analysis) were involved resection margins (hazard rate ratio [HRR] 4.08), major vascular involvement (HRR 2.20), distal bile duct or pancreatic origin of carcinoma (HRR 1.93), and perioperative blood transfusion of more than 4 U (HRR 1.76). Tumor size (> 2 cm), regional lymph node involvement, and a poor differentiation grade were overall negative factors in univariate analysis but not in the subgroup of ampullary carcinoma.
  
  
  CONCLUSIONS
  Involvement of resection margins, major vascular ingrowth, site of origin of carcinoma, and perioperative blood transfusion were independent prognostic factors for survival after PD. Overall 5-year survival was 31%, and subtotal PD is advocated for all patients with a macroscopically resectable tumor in the pancreatic head region without major vascular involvement, even for those with larger tumors or local lymph node metastasis. Care should be taken to limit the need for perioperative blood transfusions.
authors.affiliation: Department of Surgery, University of Amsterdam, The Netherlands.
authors.forename: J H
authors.initials: JH
authors.lastname: Allema
authors.forename: M E
authors.initials: ME
authors.lastname: Reinders
authors.forename: T M
authors.initials: TM
authors.lastname: van Gulik
authors.forename: M J
authors.initials: MJ
authors.lastname: Koelemay
authors.forename: D J
authors.initials: DJ
authors.lastname: Van Leeuwen
authors.forename: L T
authors.initials: LT
authors.lastname: de Wit
authors.forename: D J
authors.initials: DJ
authors.lastname: Gouma
authors.forename: H
authors.initials: H
authors.lastname: Obertop
mesh_terms: D000368:Aged; D001650:Bile Duct Neoplasms / Q000401:mortality / Q000601:surgery; D002277:Carcinoma / Q000401:mortality / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000601:surgery*; D016577:Pancreaticoduodenectomy; D011379:Prognosis; D016019:Survival Analysis