Resected periampullary adenocarcinoma: 5-year survivors and their 6- to 10-year follow-up.
BACKGROUND
Many studies have reported 5-year survival data after pancreaticoduodenectomy for periampullary adenocarcinoma. This study evaluates 10-year survival in patients surviving 5 years after initial surgery.


METHODS
We reviewed all patients undergoing pancreaticoduodenectomy for periampullary adenocarcinoma from April 1970 to July 1999 at a single institution. All 5-year survivors were identified, and their subsequent 5-year survival was compared with the actuarial survival of the general population starting at 70 years of age.


RESULTS
Nine hundred fifteen patients underwent pancreaticoduodenectomy for periampullary adenocarcinoma. Follow-up was complete on 890 patients. There were 201 (23%) 5-year survivors with a median age of 65 years at initial surgery; 51% were male and 92% were Caucasian. For the 5-year survivors, the carcinoma origin was pancreatic in 46%, ampullary in 25%, distal bile duct in 17%, and duodenal in 12%. For all 5-year survivors, the subsequent 5-year actuarial survival rate was 65%, with a median survival after achieving the 5-year landmark of 7.9 additional years. The subsequent 5-year survival by site of tumor origin was 55% for pancreatic, 66% for ampullary, 74% for bile duct, and 85% for duodenal cancer. For the age-matched population, the 5-year survival rate was 87% (P<.001 when compared with those with all periampullary cancers).


CONCLUSIONS
While the 5-year survival rate for all patients with resected periampullary adenocarcinoma is only 23%, these data imply that attainment of the 5-year survival landmark carries with it an improved survival for the subsequent 5 years. While the survival rate was less than that of the age-matched population, 65% of 5-year survivors survived 5 more years, bringing them to the 10-year postresection landmark.
Riall
Taylor S
TS
Department of Surgery, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins Medical Institutions, Baltimore, MD, USA. tsriall@utmb.edu
Cameron
John L
JL
Lillemoe
Keith D
KD
Winter
Jordan M
JM
Campbell
Kurtis A
KA
Hruban
Ralph H
RH
Chang
David
D
Yeo
Charles J
CJ
D000230:Adenocarcinoma / Q000401:mortality* / Q000601:surgery; D000368:Aged; D003138:Common Bile Duct Neoplasms / Q000401:mortality / Q000601:surgery; D004067:Digestive System Neoplasms / Q000401:mortality* / Q000601:surgery; D004379:Duodenal Neoplasms / Q000401:mortality / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000601:surgery; D016577:Pancreaticoduodenectomy; D012189:Retrospective Studies; D016019:Survival Analysis