Christoph W Michalski1,2, Bing Liu1, Max Heckler1, Susanne Roth1, Huihui Sun1, Ulrike Heger1, Markus W Büchler1, Thilo Hackert3. 1. Department of Surgery, Heidelberg University Hospital, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany. 2. Martin Luther University Halle-Wittenberg, Halle, Germany. 3. Department of Surgery, Heidelberg University Hospital, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany. thilo.hackert@med.uni-heidelberg.de.
Abstract
BACKGROUND: Site-specific outcomes of resection for periampullary cancer have not been analyzed on a large, registry-based scale. METHODS: We assessed data on periampullary cancers from the SEER database. Site- and stage-specific outcomes were analyzed. Resection was compared to no resection. RESULTS: Resection was the main therapy in stages 1 and 2 (resection vs. no resection, 8644 vs. 7208 patients), was less frequent in stage 3 (1248 vs. 2783 patients) and was rarely-but still-used in stage 4 disease (541 vs. 11,212 patients). Pancreatic head (75.7%), 11.4% distal bile duct, 7.7% ampullary, and 5.3% duodenal cancers. Cancer subtype-independent median survival was 22.0 (resection) vs. 7.0 months (no resection) in stages 1 and 2, 21.0 vs. 8.0 months in stage 3, and 10.0 vs. 3.0 months in stage 4. Subtype-dependent median survival (resection vs. no resection) was 18.0 vs. 5.0 months in pancreatic head, 19.0 vs 4.0 months in distal bile duct, 41.0 vs 7.0 months in ampullary, and 38.0 vs 4.0 months in duodenal adenocarcinoma. On multivariable analysis, patient comorbidities, marital and insurance status, and income all influenced the decision to undergo resection. CONCLUSIONS: Surgery is still underutilized in the treatment of periampullary cancers. Patients with cancers originating from the duodenum or the ampulla of Vater benefit most from resectional surgery.
BACKGROUND: Site-specific outcomes of resection for periampullary cancer have not been analyzed on a large, registry-based scale. METHODS: We assessed data on periampullary cancers from the SEER database. Site- and stage-specific outcomes were analyzed. Resection was compared to no resection. RESULTS: Resection was the main therapy in stages 1 and 2 (resection vs. no resection, 8644 vs. 7208 patients), was less frequent in stage 3 (1248 vs. 2783 patients) and was rarely-but still-used in stage 4 disease (541 vs. 11,212 patients). Pancreatic head (75.7%), 11.4% distal bile duct, 7.7% ampullary, and 5.3% duodenal cancers. Cancer subtype-independent median survival was 22.0 (resection) vs. 7.0 months (no resection) in stages 1 and 2, 21.0 vs. 8.0 months in stage 3, and 10.0 vs. 3.0 months in stage 4. Subtype-dependent median survival (resection vs. no resection) was 18.0 vs. 5.0 months in pancreatic head, 19.0 vs 4.0 months in distal bile duct, 41.0 vs 7.0 months in ampullary, and 38.0 vs 4.0 months in duodenal adenocarcinoma. On multivariable analysis, patient comorbidities, marital and insurance status, and income all influenced the decision to undergo resection. CONCLUSIONS: Surgery is still underutilized in the treatment of periampullary cancers. Patients with cancers originating from the duodenum or the ampulla of Vater benefit most from resectional surgery.
Authors: M Ducreux; A Sa Cuhna; C Caramella; A Hollebecque; P Burtin; D Goéré; T Seufferlein; K Haustermans; J L Van Laethem; T Conroy; D Arnold Journal: Ann Oncol Date: 2015-09 Impact factor: 32.976
Authors: Marco La Torre; Giuseppe Nigri; Niccolò Petrucciani; Marco Cavallini; Paolo Aurello; Giulia Cosenza; Genoveffa Balducci; Vincenzo Ziparo; Giovanni Ramacciato Journal: Pancreatology Date: 2014-06-14 Impact factor: 3.996
Authors: J A M G Tol; L A A Brosens; S van Dieren; T M van Gulik; O R C Busch; M G H Besselink; D J Gouma Journal: Br J Surg Date: 2014-12-22 Impact factor: 6.939
Authors: Taylor S Riall; John L Cameron; Keith D Lillemoe; Jordan M Winter; Kurtis A Campbell; Ralph H Hruban; David Chang; Charles J Yeo Journal: Surgery Date: 2006-08-28 Impact factor: 3.982
Authors: Jin He; Nita Ahuja; Martin A Makary; John L Cameron; Frederic E Eckhauser; Michael A Choti; Ralph H Hruban; Timothy M Pawlik; Christopher L Wolfgang Journal: HPB (Oxford) Date: 2013-03-08 Impact factor: 3.647
Authors: Xavier M Keutgen; Naris Nilubol; Joanne Glanville; Samira M Sadowski; David J Liewehr; David J Venzon; Seth M Steinberg; Electron Kebebew Journal: Surgery Date: 2015-10-06 Impact factor: 3.982