ESMO Congress 2023 | OncologyPRO

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.