Non-pancreatic periampullary adenocarcinomas: an explanation for favorable prognosis
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Published on: February 2, 2024
Matthew H G Katz1, Michael Bouvet, Waddah Al-Refaie
1Department of Surgery, University of California San Diego, San Diego, California 92103, USA.
Background/Aims:
Our previous studies demonstrate that patients with non-pancreatic periampullary adenocarcinomas have a favorable prognosis relative to those with pancreatic adenocarcinoma. This study investigates histopathologic factors that contribute to the superior outcome of these patients.
Methodology:
A retrospective review of all patients explored for periampullary neoplasms at a single institution over a 20-year period.
Results:
291 patients with periampullary neoplasms underwent exploratory laparotomy, of which 185 had resectable tumors. Periampullary adenocarcinomas were resected in 120: pancreatic head (n=74), distal common bile duct (n=10), duodenum (n=5), and ampulla of Vater (n=31). The resection rate for non-pancreatic adenocarcinomas was 90%, while that of pancreatic cancers was 44% (p<0.01). Median survival for resected non-pancreatic adenocarcinomas was 38.8 months; that of pancreatic tumors was 15.3 months (p<0.01). Non-pancreatic adenocarcinomas were significantly smaller (p<0.001), better differentiated (p<0.001), and less likely to have involved nodes (p<0.001), margins (p<0.001), perineural invasion (p<0.001), or vascular invasion (p<0.2) than pancreatic adenocarcinomas.
Conclusions:
Histopathologic features of non-pancreatic periampullary adenocarcinomas significantly differentiate them from pancreatic adenocarcinoma and contribute to their relatively favorable long-term outcome following resection.