title: Results of pancreaticoduodenectomy in patients with periampullary adenocarcinoma: perineural growth more important prognostic factor than tumor localization.
abstract: OBJECTIVE
  To study the impact of perineural growth as a prognostic factor in periampullary adenocarcinoma (pancreatic head, ampulla of Vater, distal bile duct, and duodenal carcinoma).
  
  
  BACKGROUND
  Pancreatic head carcinoma is considered to have the worst prognosis of the periampullary carcinomas. Several other prognostic factors for periampullary tumors have been identified, eg, lymph node status, free resection margins, tumor size and differentiation, and vascular invasion. The impact of perineural growth as a prognostic factor in relation to the site of origin of periampullary carcinomas is unknown.
  
  
  METHODS
  Data of 205 patients with periampullary carcinomas were retrieved from our prospective database. Pancreaticoduodenectomy was performed in 121 patients. Their clinicopathological data were reviewed and analyzed in a multivariate analysis.
  
  
  RESULTS
  Perineural growth was present in 49% of the cases (37 of the 51 patients with pancreatic head carcinoma; 7 of the 30 patients with ampulla of Vater carcinoma; 7 of the 19 with distal bile duct carcinoma; and 8 of the 21 with duodenal carcinoma). Overall 5-year survival was 32.6% with a median survival of 20.7 months. Median survival in tumors with perineural growth was 13.1 months compared with 36.0 months in tumors without perineural growth (P < 0.0001) Using multivariate analysis, the following unfavorable prognostic factors were identified: perineural growth (RR = 2.90, 95% CI 1.62-5.22), nonradical resection (RR = 2.28, 95% CI 1.19-4.36), positive lymph nodes (RR = 1.96, 95% CI 1.11-3.45), and angioinvasion (RR = 1.79, 95% CI 1.05-3.06). Portal or superior mesenteric vein reconstruction and tumor localization were not of statistical significance.
  
  
  CONCLUSIONS
  Perineural growth is a more important risk factor for survival than the primary site of periampullary carcinomas.
authors.affiliation: Department of Hepato-Pancreato-Biliary Surgery & Liver Transplantation, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: Margijske H G
authors.initials: MH
authors.lastname: van Roest
authors.forename: Annette S H
authors.initials: AS
authors.lastname: Gouw
authors.forename: Paul M J G
authors.initials: PM
authors.lastname: Peeters
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Porte
authors.forename: Maarten J H
authors.initials: MJ
authors.lastname: Slooff
authors.forename: Vaclav
authors.initials: V
authors.lastname: Fidler
authors.forename: Koert P
authors.initials: KP
authors.lastname: de Jong
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness; D010190:Pancreatic Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D016577:Pancreaticoduodenectomy; D010525:Peripheral Nerves / Q000473:pathology; D011379:Prognosis; D016019:Survival Analysis