Periampullary Regional Tumors, Pylorus Preserving Whipple Procedure and more than 10-Year Survival

Introduction: This study analyzed factors affecting postoperative survival in patients with periampullary region tumors who underwent Whipple procedure and assessed survival of such patients more than 10 years. Method: Patients with periampullary pancreatic tumors who underwent Whipple procedure in the last 3 years were retrospectively analyzed. Survival rates were statistically analyzed using the Kaplan-Meier method, and compared by the log-rank test. Multivariate survival was analyzed using a Cox proportional hazards model. Results: Twenty-eight patients, 20 men and 8 women underwent surgery for periampullary tumor. There was no early mortality. Two patients had major and five had minor complications. One patient had chronic pancreatitis, one had duodenal gastrointestinal stromal tumor, and another had pancreatic neuroendocrine tumor while 25 of the patients had pancreatic, ampullary or choledochal adenocarcinoma. Postoperative survival was significantly longer in patients with ampullary than pancreatic cancer (p<0.001). Median survival rates of patients with stages I–IV tumors were 69.75, 33.80, 21.90 and 6.00 months, respectively (p<0.001). Overall survival was significantly longer in patients who received R0 resection (p<0.001) and in patients with node negative tumors (p=0.003). Survival rate was 13 folds lower in patients with portal vein resection (p=0.022). Conclusion: Despite improvements in diagnosis, surgery and adjuvant treatments, patients with periampullary tumors have a very low survival rate≥10 years, if they are histopathologically diagnosed with adenocarcinoma. Early diagnosis, extended resection and optimal adjuvant treatment are needed to extend patient survival.