title: Distribution and pathological features of pancreatic, ampullary, biliary and duodenal cancers resected with pancreaticoduodenectomy.
abstract: BACKGROUND
  Pancreatic cancer (PC) has the worst survival of all periampullary cancers. This may relate to histopathological differences between pancreatic cancers and other periampullary cancers. Our aim was to examine the distribution and histopathologic features of pancreatic, ampullary, biliary and duodenal cancers resected with a pancreaticoduodenectomy (PD) and to examine local trends of periampullary cancers resected with a PD.
  
  
  METHODS
  A retrospective review of PD between January 2000 and December 2012 at a public metropolitan database was performed. The institutional ethics committee approved this study.
  
  
  RESULTS
  There were 142 PDs during the study period, of which 70 cases were pre-2010 and 72 post-2010, corresponding to a recent increase in the number of cases. Of the 142 cases, 116 were for periampullary cancers. There were also proportionately more PD for PC (26/60, 43% pre-2010 vs 39/56, 70% post-2010, P = 0.005). There were 65/116 (56%) pancreatic, 29/116 (25%), ampullary, 17/116 (15%) biliary and 5/116 (4%) duodenal cancers. Nodal involvement occurred more frequently in PC (78%) compared to ampullary (59%), biliary (47%) and duodenal cancers (20%), P = 0.002. Perineural invasion was also more frequent in PC (74%) compared to ampullary (34%), biliary (59%) and duodenal cancers (20%), P = 0.002. Microvascular invasion was seen in 57% pancreatic, 38% ampullary, 41% biliary and 20% duodenal cancers, P = 0.222. Overall, clear margins (R0) were achieved in fewer PC 41/65 (63%) compared to ampullary 27/29 (93%; P = 0.003) and biliary cancers 16/17 (94%; P = 0.014).
  
  
  CONCLUSIONS
  This study highlights that almost half of PD was performed for cancers other than PC, mainly ampullary and biliary cancers. The volume of PD has increased in recent years with an increased proportion being for PC. PC had higher rates of nodal and perineural invasion compared to ampullary, biliary and duodenal cancers.
authors.affiliation: HPB Surgery Unit, Royal Adelaide Hospital, North Terrace, Adelaide, SA, 5000, Australia. manju.chandrasegaram@adelaide.edu.au.|Division of Surgery, School of Medicine, University of Adelaide, Adelaide, SA, 5005, Australia. manju.chandrasegaram@adelaide.edu.au.
authors.forename: Manju D
authors.initials: MD
authors.lastname: Chandrasegaram
authors.affiliation: HPB Surgery Unit, Royal Adelaide Hospital, North Terrace, Adelaide, SA, 5000, Australia. suchuenchiam@yahoo.co.uk.
authors.forename: Su C
authors.initials: SC
authors.lastname: Chiam
authors.affiliation: HPB Surgery Unit, Royal Adelaide Hospital, North Terrace, Adelaide, SA, 5000, Australia. john.chen@flinders.edu.au.|Flinders Medical Centre, Flinders Drive, Bedford Park, Adelaide, SA, 5042, Australia. john.chen@flinders.edu.au.|Flinders University, Sturt Rd, Bedford Park, Adelaide, SA, 5042, Australia. john.chen@flinders.edu.au.
authors.forename: John W
authors.initials: JW
authors.lastname: Chen
authors.affiliation: Flinders Medical Centre, Flinders Drive, Bedford Park, Adelaide, SA, 5042, Australia. aisha.khalid000@gmail.com.
authors.forename: Aisha
authors.initials: A
authors.lastname: Khalid
authors.affiliation: School of Population Health, University of Adelaide, 178 North Terrace, Adelaide, SA, 5005, Australia. murthy.mittinty@adelaide.edu.au.
authors.forename: Murthy L
authors.initials: ML
authors.lastname: Mittinty
authors.affiliation: HPB Surgery Unit, Royal Adelaide Hospital, North Terrace, Adelaide, SA, 5000, Australia. eu.neo@health.sa.gov.au.|Flinders Medical Centre, Flinders Drive, Bedford Park, Adelaide, SA, 5042, Australia. eu.neo@health.sa.gov.au.
authors.forename: Eu L
authors.initials: EL
authors.lastname: Neo
authors.affiliation: HPB Surgery Unit, Royal Adelaide Hospital, North Terrace, Adelaide, SA, 5000, Australia. tanchuanping@gmail.com.
authors.forename: Chuan P
authors.initials: CP
authors.lastname: Tan
authors.affiliation: HPB Surgery Unit, Royal Adelaide Hospital, North Terrace, Adelaide, SA, 5000, Australia. paul.dolan@health.sa.gov.
authors.forename: Paul M
authors.initials: PM
authors.lastname: Dolan
authors.affiliation: HPB Surgery Unit, Royal Adelaide Hospital, North Terrace, Adelaide, SA, 5000, Australia. mark.brooke-smith@flinders.edu.au.|Flinders Medical Centre, Flinders Drive, Bedford Park, Adelaide, SA, 5042, Australia. mark.brooke-smith@flinders.edu.au.|Flinders University, Sturt Rd, Bedford Park, Adelaide, SA, 5042, Australia. mark.brooke-smith@flinders.edu.au.
authors.forename: Mark E
authors.initials: ME
authors.lastname: Brooke-Smith
authors.affiliation: Division of Surgery, School of Medicine, University of Adelaide, Adelaide, SA, 5005, Australia. Kanhere.Harsh@health.sa.gov.au.|HPB Surgery Unit, Queen Elizabeth Hospital, 28 Woodville Road, Adelaide, SA, 5011, Australia. Kanhere.Harsh@health.sa.gov.au.
authors.forename: Harsh
authors.initials: H
authors.lastname: Kanhere
authors.affiliation: HPB Surgery Unit, Royal Adelaide Hospital, North Terrace, Adelaide, SA, 5000, Australia. chris.worthley@health.sa.gov.au.
authors.forename: Chris S
authors.initials: CS
authors.lastname: Worthley
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014670:Ampulla of Vater / Q000473:pathology* / Q000601:surgery; D001661:Biliary Tract Neoplasms / Q000473:pathology* / Q000601:surgery; D003138:Common Bile Duct Neoplasms / Q000473:pathology* / Q000601:surgery; D004379:Duodenal Neoplasms / Q000473:pathology* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D010190:Pancreatic Neoplasms / Q000473:pathology* / Q000601:surgery; D016577:Pancreaticoduodenectomy; D011379:Prognosis; D012189:Retrospective Studies