Is perineural invasion more accurate than other factors to predict early recurrence after pancreatoduodenectomy for pancreatic head adenocarcinoma?
BACKGROUND
Some patients operated by pancreaticoduodenectomy for resectable pancreatic head adenocarcinoma will present with a recurrence during the first year (early recurrence).


OBJECTIVE
The aim of this study was to determine prognostic factors associated with early recurrence in a large retrospective study.


METHODS
From January 1995 to November 2010, all patients operated by pancreaticoduodenectomy for pancreatic head adenocarcinoma in our institution were retrospectively included. Univariate and multivariate analyses were performed to determine factors associated with early recurrence.


RESULTS
A total of 166 patients were included; 57 patients (34%) developed early recurrence. In univariate analysis, factors associated with early recurrence were perineural invasion (p = 0.0002), preoperative bilirubin (p = 0.01), lymph node ratio (LNR) ≥0.2 (p = 0.009), and T stage (p = 0.02). In multivariate analysis, perineural invasion (odds ratio [OR] 3.31; 95% confidence interval [CI] 1.42-7.72; p = 0.005), LNR ≥0.2 (OR 2.55; 95% CI 1.17-5.52; p = 0.02), and preoperative bilirubin (OR 1.04; 95% CI 1.01-1.07; p = 0.03) were independent factors associated with early recurrence. Perineural invasion was also associated with poor overall survival (p = 0.001) and poor disease-free survival (p = 0.07).


CONCLUSIONS
In our study, perineural invasion (OR 3.31) is more accurate than T stage and lymph node status (OR 2.55) to predict early recurrence after pancreatoduodenectomy for pancreatic head adenocarcinoma.
Department of HPB Surgery, University Hospital Nancy, Rue du Morvan, 54500, Vandoeuvre les Nancy, France.
Thibaut
T
Fouquet
Adeline
A
Germain
Laurent
L
Brunaud
Laurent
L
Bresler
Ahmet
A
Ayav
D000230:Adenocarcinoma / Q000097:blood / Q000556:secondary* / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001663:Bilirubin / Q000097:blood; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000097:blood / Q000473:pathology*; D010190:Pancreatic Neoplasms / Q000097:blood / Q000473:pathology* / Q000601:surgery; D016577:Pancreaticoduodenectomy; D010525:Peripheral Nerves / Q000473:pathology*; D057234:Preoperative Period; D012189:Retrospective Studies; D015996:Survival Rate; D055815:Young Adult
D001663:Bilirubin