"Treatment Patterns and Survival Outcomes in Periampullary Carcinoma: A Multicentric Retrospective Study from the...

Periampullary carcinoma (PA Ca) management and outcome data from low and middle-income countries (LMICs) is limited. This multicentric retrospective study examines treatment patterns and outcomes of such patients in the Indian subcontinent. This study was conducted at four tertiary cancer centers in India from January 2019 to December 2023. Following ethical approval, patient data were retrieved to analyze treatment patterns and outcomes. Statistical analysis was performed using SPSS Statistics (Version 23.0). Comparative survival analysis with previous studies was conducted to contextualize findings. A total of 95 patients were included, with a median age of 56 years, 56 males (59%) and 39 females (41%). The most common presenting symptoms were jaundice (69.7%) and abdominal pain (61.7%). Risk factors included alcohol consumption (17.8%) and smoking (15.7%), with diabetes (32.6%) and hypertension (24.2%) as common comorbidities. The most frequent tumor location was the ampulla (46.3%), followed by the head of the pancreas (34.7%), distal common bile duct (10.5%), and duodenum (8.4%). 78% had non-metastatic disease at presentation, while 22% had metastatic disease. Sixty-five patients underwent upfront surgery, achieving R0 resection in 97% of cases. The most common histological subtype was pancreatic adenocarcinoma (53%). Pathological T2 and T3 stages were observed in 46% and 40% of cases, respectively. In the R0 resection group, the median disease-free survival (DFS) was not reached, with 2-year DFS at 80.6%. and 3-year DFS at 62.7%. For R1 resection and metastatic disease, the median progression-free survival (PFS) was 17 months (95% CI: 8-26 months), with median overall survival (OS) not reached. To our knowledge, this is the first multicenter study from India providing real-world data on PA Ca management. Early-stage PA Ca in India demonstrates high resectability and favorable survival. Further research is imperative to refine PA Ca management strategies and optimize outcomes.