Abstract 1651P
Background
The exact origin and associated prognosis of periampullary adenocarcinoma might be challenging to determine, especially in bulky tumours, due to the destruction of normal periampullary anatomy and the extension of the tumour beyond a single periampullary structure. Periampullary carcinomas are typically divided into pancreatobiliary and intestinal types according to histological differentiation. The aim of this study was to determine the prognostic value of this histological differentiation by comparing various clinic-pathological prognostic factors and surgical outcome in periampullary carcinoma cases that underwent pancreaticoduodenectomy.
Methods
From May 2018 to April 2021, 60 consecutive cases of periampullary carcinoma who underwent pancreaticoduodenectomy were included in this study. Cases were divided into two groups: pancreatobiliary and intestinal types. Various clinical and histopathological prognostic variables were analysed, and the association of these variables with pancreatobiliary and intestinal variants of periampullary carcinoma was determined using Chi-square and Fischer’s exact tests.
Results
20 cases were included in the pancreatobiliary group, and 40 cases were included in the intestinal group. These groups were comparable in terms of age, sex, nutritional status, and bilirubin levels. Pancreatobiliary type was more frequently associated with nodal disease (p<0.01), lymphovascular invasion (p<0.01) and perineural invasion (p=0.018). Post-operative morbidity was significantly higher in the pancreatobiliary group (p=0.043). Table: 1651P
| S.No. | Variable | Periampullary Carcinoma | x2 | p-value | ||
| Pancreatobiliary Type | Intestinal Type | |||||
| 1 | Age (years) | <60 | 15 | 32 | 0.196 | 0.658 |
| >60 | 5 | 8 | ||||
| 2 | Sex | Male | 12 | 19 | 0.834 | 0.361 |
| Female | 8 | 21 | ||||
| 3 | Comorbidity | Yes | 6 | 16 | 0.574 | 0.449 |
| No | 24 | 24 | ||||
| 4 | Bilirubin (mg/dl) | <5 | 8 | 8 | 2.73 | 0.099 |
| >5 | 12 | 32 | ||||
| 5 | Albumin (g/dl) | < 3 | 8 | 11 | 0.96 | 0.326 |
| > 3 | 12 | 29 | ||||
| 6 | Pancreas Texture | Firm | 10 | 21 | 0.03 | 0.855 |
| Soft | 10 | 19 | ||||
| 7 | MPD | <3mm | 6 | 5 | 2.73 | 0.99 |
| >3mm | 14 | 35 | ||||
| 8 | Tumor size | >2cm | 8 | 21 | 0.834 | 0.361 |
| <2cm | 12 | 19 | ||||
| 9 | Nodal status | Positive | 12 | 10 | 7.03 | 0.008 |
| Negative | 8 | 30 | ||||
| 10 | Lymphovascular Invasion | Present | 12 | 9 | 8.24 | 0.004 |
| Absent | 8 | 31 | ||||
| 11 | Perineural Invasion | Present | 7 | 4 | 5.57 | 0.018 |
| Absent | 13 | 36 | ||||
| 12 | Grade | 1 | 10 | 15 | 0.857 | 0.355 |
| 2/3 | 10 | 25 | ||||
| 13 | Post-operative Morbidity | Yes | 11 | 08 | 4.10 | 0.043 |
| No | 9 | 32 |
Conclusions
After pancreaticoduodenectomy, periampullary cancer of the pancreatobiliary type is linked to worse post-operative outcome and unfavourable histopathological prognostic markers. Therefore, after surgery, these cases should follow management algorithms with aggressive adjuvant therapy protocols.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.
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