799 Positive Resected Lymph Nodes, Five-Year Recurrence/survival and Overall Survival After Pancreatoduodenectomy for Ampullary Adenocarcinoma
M Mariathasan, N Grayson, J Ribaud, A Nair, P Srinivasan,- Surgery
Abstract
Aim
Pancreatoduodenectomy (PD) is recommended in patients with resectable ampullary adenocarcinoma (AA). This study aimed to quantify the correlation between histologically involved lymph nodes and survival using a large multicentre cohort.
Method
Data were extracted from the Recurrence After Whipple’s (RAW) study, a multicentre retrospective cohort study of outcomes following pancreatoduodenectomy for pancreatic head malignancy (29 centres in 8 countries, n = 1484). Patients with histologically confirmed AA were identified and grouped by their number of positive resected nodes. Five-year survival rates and median estimated survival were compared using Fisher’s exact test, Kaplan-Meier method and the log-rank test.
Results
In total, 394 patients (26.5%) had AA. 212 (55.1%) patients had <2 involved nodes and 173 (44.9%) had ≥2 involved nodes (data unavailable for nine patients). The former had reduced five-year recurrence (29.2% vs 64.2%, p<0.0001) and increased five-year survival (69.8% vs 33.5%, p<0.00001). The number of patients with zero, one and two or more positive nodes was 37 (20.8%), 27 (15.2%) and 114 (64.0%), respectively (patients with missing data were excluded). Median survival was 787 (95% confidence interval: 526-1048), 515 (423-607) and 567 (501-632) days, respectively (p = 0.01).
Conclusions
In our multicentre study, a histological finding of <2 positive lymph nodes was associated with reduced five-year recurrence and increased five-year survival in patients who underwent PD for AA. Patients with positive lymph nodes had reduced median survival when compared to those without positive nodes. However, patients with only one positive node did not survive longer than those with two or more positive nodes.