[Results of pancreaticoduodenectomy in the treatment of periampullary tumors].
BACKGROUND
The diagnosis and treatment of periampullary tumors represents a challenge for current medicine.


OBJECTIVE
To review the results of pancreaticoduodenectomy (PDD) in the treatment of periampullary tumors and to identify risk factors that impact the long-term survival.


METHODS
We performed a retrospective study of patients who underwent a PDD for periampullary tumors between 1993 and 2009. We reviewed perioperative results and long term survival. We performed a multivariate analysis for long-term survival.


RESULTS
A PDD was performed in 181 patients aged 58 ± 12 years (98 females). Pyloric preservation was done in 53% and a pancreatogastric anastomosis was used in 94% of cases. Morbidity was 62% and postoperative mortality was 5.5%. Pancreatic cancer was the most frequent pathological finding in 41%, followed by ampullary cancer in 28% and distal bile duct cancer in 16%. Median survival was 17 months, with a five years survival of 24%. Survival for ampullary tumors was 28 months with a five years survival of 32%. The median and five years survival were 14 months and 16% for bile duct cancer and 11 months and 14% for pancreatic cancer. Multivariate analysis identified tumor type (pancreas /bile duct) and lymph node dissemination as independent predictors of mortality.


CONCLUSIONS
One quarter of patients experienced long term survival. Mortality predictors were tumor type and lymph node dissemination.
Cirugía Digestiva, Servicio de Cirugía, Hospital Sótero del Río, Chile. enorero@yahoo.com
Enrique
E
Norero
Eduardo
E
Viñuela
Sergio
S
Báez
Cristian
C
Martínez
Julio
J
Reyes
Rodrigo
R
Kusanovic
Marcel
M
Sanhueza
Gloria
G
Aguayo
Alfonso
A
Calvo
Rose Marie
RM
Mege
Mario
M
Caracci
Alfonso
A
Díaz
D014670:Ampulla of Vater / Q000473:pathology / Q000601:surgery*; D021441:Carcinoma, Pancreatic Ductal / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D003138:Common Bile Duct Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects / Q000401:mortality*; D012189:Retrospective Studies; D015996:Survival Rate