title: Factors affecting survival in patients who underwent pancreaticoduodenectomy for periampullary cancers.
abstract: OBJECTIVE
  The purpose of this study was to determine the factors affecting survival in patients who underwent pancreaticoduodenectomy for periampullary cancers and to discuss the outcomes of our findings.
  
  
  METHODS
  This retrospective study included 79 patients who underwent pancreaticoduodenectomy for periampullary cancers between September 1987 and October 2011 in the Department of General Surgery at Ondokuz Mayis University School of Medicine. The factors of age, tumor localization, tumor size, lymphovascular invasion, status of lymph node metastasis, tumor differentiation, preoperative CA 19-9 levels, preoperative total bilirubin levels, preoperative albumin levels, and preoperative biliary drainage were investigated to determine their influence on survival. The survival periods were calculated using the Kaplan-Meier method. The log-rank test was used for comparison of the prognostic factors. The independent prognostic factors affecting survival were determined by Cox hazard regression analysis and hazard ratios (HR) and 95% confidence intervals (CI) were calculated. P<0.05 was considered as significant.
  
  
  RESULTS
  The following were identified as independent prognostic factors adversely affecting survival: tumor size ≥2 cm (HR: 2.0, 95% CI: 0.27-0.90), lymphovascular invasion (HR: 2.9, 95% CI: 0.18-0.60), CA 19-9 levels ≥100 U/mL (HR: 2.0, 95% CI: 0.26-0.90), and albumin levels <2.5 mg/dL (HR: 2.7, 95% CI: 1.14-6.66).
  
  
  CONCLUSIONS
  The independent prognostic factors identified in this study can be used for selection of patients for whom pancreaticoduodenectomy should be applied for periampullary cancers. These factors could help us to estimate survival rates.
authors.affiliation: Clinic of General Surgery, Çankırı State Hospital, Çankırı, Turkey.
authors.forename: Temel Deniz
authors.initials: TD
authors.lastname: Şeren
authors.affiliation: Department of General Surgery, İstanbul Kemerburgaz University Faculty of Medicine, İstanbul, Turkey.
authors.forename: Koray
authors.initials: K
authors.lastname: Topgül
authors.affiliation: Clinic of General Surgery, Korgan State Hospital, Ordu, Turkey.
authors.forename: Bülent
authors.initials: B
authors.lastname: Koca
authors.affiliation: Department of General Surgery, Ondokuz Mayıs University Faculty of Medicine, Samsun, Turkey.
authors.forename: Kenan
authors.initials: K
authors.lastname: Erzurumlu
keywords: Periampullary tumors; pancreatic carcinoma; pancreaticoduodenectomy; prognostic factor