Factors Affecting Survival After Pancreaticoduodenectomy

2. Factors Affecting Survival After Pancreaticoduodenectomy By AMGAD A. FOUAD Professor Of Surgery Gastroenterology Center Mansoura University.

3. Pancreatic cancer is the fourth most common cause of cancer related mortality in the western world • It accounts for 10 % of all cancers of the digestive tract. ( Moossa & Stabile 1995)

4. Most patients with pancreatic cancer present late in the course of the disease and have locally extensive disease ± Metastasis

5. Overall only up to 20 % of patients are candidates for resection and have potential for curative surgery this late presentation is a combination of delays related to: • Patient presentation • Physician misdiagnosis • Lack of screening programs (Moossa& Gamagami , 1995)

6. In the management of periampulary tumors , resection is the only likelihood for cure and pancreaticoduodenectomy continues to be the surgical procedure of choice (Watanapa , et al 1992 )

7. Although a low mortality rate has been achieved , the incidence of morbidity still high even in recent reports . (Rosso et al 2006 )

8. Ampulary carcinoma has a relatively better prognosis and a 5–year survival rates approaching 50 % Whereas • Pancreatic cancer has a less favorable prognosis and a 5-year survival rate < 25 % ( Sarmiento & Sarr, 2001 )

9. Many factors have been identified to be associated with a more favorable prognosis and a better survival after pancreaticoduodenectomy ( Fung et al, 2002)

10. Aim of the work • Evaluation of different prognostic factors that may influence the overall survival after pancreaticoduodenectomy in patients with periampulary tumours .

11. Patients and Methods • Retrospective study • GEC – Mansoura University • Series 154 patients . • Sep 2001 → April 2004

12. Patient evaluation • Thorough history • Clinical examination • Complete laboratory work up • Radiological eval : • US • CT

13. Pancreaticoduodenal resection classic whipple with • Pancreateco–gastrostomy • Gastro- jejunostomy • Hepatico- jejunostomy

15. All Specimen Were Histologically Examined • Site of origin • Degree of diff. • LN status. • Safety margins.

16. Results

17. GEC Mansoura University • Series 154 Patients • 97 ♂ ( 62.9 % ) • 57 ♀ ( 37.1 % ) • Age : • Mean 52 ± 11 Y • Median 53 Y • Range 34 – 80 Y

18. Patient Presentations

19. Preop Lab Data Ast : Aspartate Transaminase , ALT : Alanine Transaminase , CEA : Carcinoemberyonic Antigen CA 19 -9 : Carbohydrate Antigen 19 -9

20. CT Findings ( 154 patients )

22. Pathological Features after PD in 154 patients with periampulary carcinoma

25. 1,2,3 Years survival of studied cases according to different

26. Median Survival Of Studied Cases According To Different Factors

27. Median recurrence free survival according to different factors:

31. Conclusion • Periampulary carcinoma represents a major therapeutic challenge to surgeons . Despite resent improvement in Hospital mortality and morbidity , the long-term survival after pancreaticoduodenectomy is still disappointing and many factors should be considered to improve the outcome

32. We believe that , the age of the patient , the site of origin of the tumor, cellular differentiation , the pathological tumour stage , the resection margin and the amount of blood transfusion all are important prognostic factors and should be considered in selecting patients eligible to surgical resection

33. Thank you