title: Long-Term Outcomes and Prognostic Factors in Periampullary Carcinoma.
abstract: OBJECTIVE
  The aim of the study was to analyze the long-term survival and the various prognostic factors that influence overall survival in patients undergoing pancreaticoduodenectomy (PD) with non-pancreatic periampullary carcinomas.
  
  
  METHODS
  A retrospective analysis of consecutive patients diagnosed with non-pancreatic periampullary carcinomas who underwent PD at a tertiary cancer center was performed. Univariate analysis of various prognostic factors influencing the disease-free survival (DFS) was performed using log-rank test. Factors identified to be significant in univariate analysis were included in the multivariate analysis, which was performed using the Cox proportional hazard model. The survival estimates were calculated by life-table method. Statistical significance was considered when p value was <0.05. The SPSS v16.0.1 software was used for statistical analysis.
  
  
  RESULTS
  Between 1995 and 2010, 78 patients underwent PD with or without (Whipple's operation) pylorus preservation for non-pancreatic periampullary adenocarcinomas. Of these, eight patients received adjuvant chemotherapy. The most common subsite was ampulla (60 patients), followed by the second part duodenum (11 patients), and distal common bile duct (7 patients). The median duration of follow-up of all patients in this study was 50 months. The recurrence rate was 39.7 %. The 5-year disease-free survival and overall survival was 57 %. Patients without nodal metastasis had a non-significant trend towards better 5-year disease-free survival when compared to those with nodal metastasis (64 vs 45 %, p = 0.11). On multivariate analysis, it was found that male gender (p = 0.05) and presence of lymphovascular invasion (p = 0.04) predicted a significantly poor 5-year disease-free survival.
  
  
  CONCLUSIONS
  Periampullary carcinomas have a favorable prognosis after surgery. Male gender and presence of lymphovascular invasion are independent prognostic factors in patients diagnosed with non-pancreatic periampullary carcinomas who underwent PD in this study.
authors.affiliation: Department of Surgical Oncology, Cancer Institute (WIA), Dr. S. Krishnamurthy Campus, No.18, Sardar Patel road, Guindy, Chenai, 600036, India.
authors.forename: Bhanu Jayanand
authors.initials: BJ
authors.lastname: Sunil
authors.affiliation: Department of Surgical Oncology, Cancer Institute (WIA), Dr. S. Krishnamurthy Campus, No.18, Sardar Patel road, Guindy, Chenai, 600036, India. ram_a_s@yahoo.com.
authors.forename: Ramakrishnan A
authors.initials: RA
authors.lastname: Seshadri
authors.affiliation: Department of Surgical Oncology, Sri Ramachandra Medical University, Chennai, India.
authors.forename: S
authors.initials: S
authors.lastname: Gouthaman
authors.affiliation: Department of Biostatistics, Cancer Institute (WIA), Chennai, India.
authors.forename: Rama
authors.initials: R
authors.lastname: Ranganathan
mesh_terms: D000328:Adult; D000368:Aged; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000401:mortality* / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000401:mortality*; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D016019:Survival Analysis; D013995:Time; D016896:Treatment Outcome
keywords: Lymphovascular invasion; Pancreaticoduodenectomy; Periampullary carcinoma; Prognostic factors; Survival