title: Surgical morbidity, mortality, and long-term survival in patients with peripancreatic cancer following pancreaticoduodenectomy.
abstract: BACKGROUND
  Surgical resection of the primary tumor in peripancreatic cancer has been associated with an improved survival and decreased morbidity in the recent literature. The purpose of this review was to analyze the results at a single institution.
  
  
  METHODS
  Between 1985 and 1995, 88 patients underwent a pancreaticoduodenectomy for adenocarcinoma of the pancreatic head region and had complete long-term follow-up. Patient records were reviewed to determine morbidity, mortality, and survival.
  
  
  RESULTS
  Tumor histology included pancreatic head adenocarcinoma (n = 46), ampullary adenocarcinoma (n = 28), duodenal adenocarcinoma (n = 8), and cholangiocarcinoma (n = 6). Morbidity occurred in 26 patients (29%). Perioperative mortality was seen in 6 patients (7%). No perioperative mortality was seen over the last 3 years, which included 33 patients. The mean follow-up was 29 months, with a median survival of 19 months. At last follow-up, 24 patients were alive without disease with an average survival of 43 months (1 to 141). There were 54 patients who died with cancer with an average survival of 21 months (1 to 117). Based on Kaplan and Meier statistical analysis the estimated survival was 47% at 2 years and 25% at 5 years. The location of the primary tumor (P = 0.0006) and the presence of positive lymph nodes (P = 0.05) was shown to have a negative impact on survival.
  
  
  CONCLUSIONS
  Pancreaticoduodenectomy can be done with acceptable morbidity and mortality. The outlook with this disease remains poor, but long-term survival can be achieved in some patients.
authors.affiliation: Department of Surgery, Baylor University Medical Center, Dallas, Texas, USA.
authors.forename: J
authors.initials: J
authors.lastname: Stephens
authors.forename: J
authors.initials: J
authors.lastname: Kuhn
authors.forename: J
authors.initials: J
authors.lastname: O'Brien
authors.forename: J
authors.initials: J
authors.lastname: Preskitt
authors.forename: H
authors.initials: H
authors.lastname: Derrick
authors.forename: T
authors.initials: T
authors.lastname: Fisher
authors.forename: R
authors.initials: R
authors.lastname: Fuller
authors.forename: Z
authors.initials: Z
authors.lastname: Lieberman
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014670:Ampulla of Vater; D018281:Cholangiocarcinoma / Q000401:mortality / Q000601:surgery; D003138:Common Bile Duct Neoplasms / Q000401:mortality / Q000601:surgery*; D004379:Duodenal Neoplasms / Q000401:mortality / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000601:surgery*; D016577:Pancreaticoduodenectomy; D012189:Retrospective Studies; D016019:Survival Analysis