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Prognostic Factors and the Role of Adjuvant Treatment in Periampullary Carcinoma: a Single-Centre Experience of 95 Patients

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Abstract

Purpose

The effect of adjuvant treatment on those undergoing pancreaticoduodenectomy (PD) for periampullary carcinomas (PAC) is not well studied. Most studies employed chemoradiation as the adjuvant modality. We aimed to analyse clinicopathological differences between types of PACs, the prognostic factors and the role of adjuvant therapy (chemotherapy in the majority).

Methods

Patients with PAC who underwent PD from Jan 2011 to Dec 2015 were retrospectively analysed.

Results

Ninety-five patients with PAC underwent PD in the study period. Ampullary carcinoma (AC) was the most common. Pancreatic carcinomas (PC) were larger. AC had lower T stage, perineural invasion (PNI) and R1 resections. Median overall survival (OS) was 32.7 months. On multivariate analysis, lymph node ratio (LNR) ≥ 0.2 and advanced T stage adversely affected the OS. Fifty-seven (66.3%) patients received adjuvant treatment, of which 50 had chemotherapy alone. Adjuvant treatment resulted in better OS in patients with T stage ≥ 3, lymph node involvement, LNR ≥ 0.2, lymphovascular invasion, PNI, tumour size > 2 cm, higher grade and distal cholangiocarcinoma.

Conclusion

In patients of PAC undergoing PD, AC had favourable clinicopathological profile. LNR ≥ 0.2 and advanced T stage adversely affected OS. Adjuvant treatment resulted in significantly better OS in patients with high-risk features.

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Funding

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Authors and Affiliations

  1. Department of Medical Oncology, Institute of Liver and Biliary Sciences, Vasant Kunj, New Delhi, 110070, India

    Saphalta Baghmar

  2. Department of Hepatopancreatobiliary Surgery, Institute of Liver and Biliary Sciences, Vasant Kunj, New Delhi, 110070, India

    Nikhil Agrawal, Senthil Kumar, Tushar Kanti Chattopadhyay, Asit Arora & Viniyendra Pamecha

  3. Department of Biostatistics, Institute of Liver and Biliary Sciences, Vasant Kunj, New Delhi, 110070, India

    Guresh Kumar

  4. Department of Pathology, Institute of Liver and Biliary Sciences, Vasant Kunj, New Delhi, 110070, India

    Chhagan Bihari

  5. Department of Radiology, Institute of Liver and Biliary Sciences, Vasant Kunj, New Delhi, 110070, India

    Yashwant Patidar

  6. Department of Medical Oncology, Indraprasth Apollo Hospital, New Delhi, 110076, India

    Dipanjan Panda

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  1. Saphalta Baghmar
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  2. Nikhil Agrawal
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Contributions

Conception and design: Dr. Saphalta, Dr. Nikhil, Dr. Yashwant, Dr. Chhagan. Administrative support: Dr. Tushar Kanti Chattopadhyay. Provision of study materials or patients: Dr. Dipanjan, Dr. Nikhil, Dr. Asit, Dr. Senthil. Collection and assembly of data: Dr. Saphalta. Data analysis and interpretation: Dr. Guresh. Manuscript writing: All authors. Final approval of manuscript: All authors.

Corresponding author

Correspondence to Nikhil Agrawal.

Ethics declarations

The study was approved by the institutional review board. The document number is 25/5/107/ILBS/AC/2016/11252/154-159.

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The authors declare that they have no conflict of interest.

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Baghmar, S., Agrawal, N., Kumar, G. et al. Prognostic Factors and the Role of Adjuvant Treatment in Periampullary Carcinoma: a Single-Centre Experience of 95 Patients. J Gastrointest Canc 50, 361–369 (2019). https://doi.org/10.1007/s12029-018-0058-7

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  • DOI: https://doi.org/10.1007/s12029-018-0058-7

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