Different Periampullary Types and Subtypes Leading to Different Perioperative Outcomes of Pancreatoduodenectomy: Reality and Not a Myth; An International Multicenter Cohort Study

Simple Summary: For cancer in the periampullary region, surgical resection with pancreatoduodenectomy remains the main curative treatment. Variations in prognosis suggest distinct growth patterns and tissue reactions, potentially influencing complications and perioperative mortality. This study aims...

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Detalles Bibliográficos
Autores: Uijterwijk, BA, Lemmers, DH, Fusai, GK, Koerkamp, BG, Koek, S, Zerbi, A, Sparrelid, E, Boggi, U, Luyer, M, Ielpo, B, Salvia, R, Goh, BKP, Kazemier, G, Björnsson, B, Serradilla-Martín, M, Mazzola, M, Mavroeidis, VK, Sánchez-Cabús, S, Pessaux, P, White, S, Alseidi, A, Valle, RD, Korkolis, D, Bolm, LR, Soonawalla, Z, Roberts, KJ, Vladimirov, M, Mazzotta, A, Kleeff, J, Muñoz, MAS, Besselink, MG, Hilal, MA
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2024
País:España
Institución:Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau)
Repositorio:r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau
OAI Identifier:oai:iibsantpau.fundanetsuite.com:p17777
Acceso en línea:https://iibsantpau.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=17777
http://ddd.uab.cat/record/305604
Access Level:acceso abierto
Palabra clave:non-pancreatic periampullary cancer
complications
pancreatoduodenectomy
tumor behavior
Descripción
Sumario:Simple Summary: For cancer in the periampullary region, surgical resection with pancreatoduodenectomy remains the main curative treatment. Variations in prognosis suggest distinct growth patterns and tissue reactions, potentially influencing complications and perioperative mortality. This study aims to explore the impact of the type of periampullary adenocarcinoma on the perioperative hospital course. This international multicenter cohort study included 30 centers. Patients with duodenal adenocarcinoma (DAC), intestinal-type (AmpIT) and pancreatobiliary-type (AmpPB) ampullary adenocarcinoma, distal cholangiocarcinoma (dCCA), and pancreatic ductal adenocarcinoma (PDAC) were included. The primary outcome was 30-day or in-hospital mortality, and secondary outcomes were major morbidity (Clavien-Dindo 3b >=), clinically relevant post-operative pancreatic fistula (CR-POPF), and length of hospital stay (LOS). Results: Overall, 3622 patients were included in the study (370 DAC, 811 AmpIT, 895 AmpPB, 1083 dCCA, and 463 PDAC). Mortality rates were comparable between DAC, AmpIT, AmpPB, and dCCA (ranging from 3.7% to 5.9%), while lower for PDAC (1.5%, p = 0.013). Major morbidity rate was the lowest in PDAC (4.4%) and the highest for DAC (19.9%, p < 0.001). The highest rates of CR-POPF were observed in DAC (27.3%), AmpIT (25.5%), and dCCA (27.6%), which were significantly higher compared to AmpPB (18.5%, p = 0.001) and PDAC (8.3%, p < 0.001). The shortest LOS was found in PDAC (11 d vs. 14-15 d, p < 0.001). Discussion: In conclusion, this study shows significant variations in perioperative mortality, post-operative complications, and hospital stay among different periampullary cancers, and between the ampullary subtypes. Further research should assess the biological characteristics and tissue reactions associated with each type of periampullary cancer, including subtypes, in order to improve patient management and personalized treatment.

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