TY - JOUR
T1 - Different Periampullary Types and Subtypes Leading to Different Perioperative Outcomes of Pancreatoduodenectomy
T2 - Reality and Not a Myth; An International Multicenter Cohort Study
AU - Uijterwijk, Bas A.
AU - Lemmers, Daniël H.
AU - Fusai, Giuseppe Kito
AU - Groot Koerkamp, Bas
AU - Koek, Sharnice
AU - Zerbi, Alessandro
AU - Sparrelid, Ernesto
AU - Boggi, Ugo
AU - Luyer, Misha
AU - Ielpo, Benedetto
AU - Salvia, Roberto
AU - Goh, Brian K. P.
AU - Kazemier, Geert
AU - Björnsson, Bergthor
AU - Serradilla-Martín, Mario
AU - Mazzola, Michele
AU - Mavroeidis, Vasileios K.
AU - Sánchez-Cabús, Santiago
AU - Pessaux, Patrick
AU - White, Steven
AU - Alseidi, Adnan
AU - Valle, Raffaele Dalla
AU - Korkolis, Dimitris
AU - Bolm, Louisa R.
AU - Soonawalla, Zahir
AU - Roberts, Keith J.
AU - Vladimirov, Miljana
AU - Mazzotta, Alessandro
AU - Kleeff, Jorg
AU - on behalf of ISGACA Consortium
AU - Suarez Muñoz, Miguel Angel
AU - Besselink, Marc G.
AU - Hilal, Mohammed Abu
N1 - Publisher Copyright: © 2024 by the authors.
PY - 2024/3/1
Y1 - 2024/3/1
N2 - 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.
AB - 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.
KW - complications
KW - non-pancreatic periampullary cancer
KW - pancreatoduodenectomy
KW - tumor behavior
UR - http://www.scopus.com/inward/record.url?scp=85187909558&partnerID=8YFLogxK
U2 - 10.3390/cancers16050899
DO - 10.3390/cancers16050899
M3 - Article
C2 - 38473260
SN - 2072-6694
VL - 16
JO - Cancers
JF - Cancers
IS - 5
M1 - 899
ER -