Pancreaticoduodenectomy for XXXX : surgical results, prognostic factors, and long-term follow-up.

@entity1 @entity548 @entity5 @entity660 @entity532 @entity1126 @entity201 @entity3472 @entity356
PURPOSE: Prognostic indicators for @entity201 have not been widely confirmed because of its rarity. Despite the early appearance of symptoms, it has a very poor prognosis. The aim of this study was to identify prognostic factors in @entity1 undergoing pancreaticoduodenectomy (PD) for @entity1126 ( @entity1126 ) in a high-volume center for @entity660 . METHODS: From January 2000 to December 2013, 1490 PD were performed for periampullary disease. Data from all @entity1 with histologically proven @entity201 were reviewed. Preoperative data, post-operative complications, pathologic features, and survival were investigated. RESULTS: Among 50 histologically proven @entity1126 (3.3  %), 4 @entity1 who underwent CBD resection were excluded. Thus, the study population consisted of 46 @entity1 . Overall surgical morbidity rate was 67.4  %; mortality was nil. @entity532 were @entity3472 (47.8  %), abdominal collections (34.8  %), post-pancreatectomy @entity548 (21.7  %), and delayed @entity356 (10.9  %). The majority of resections were R0 (73.9  %). The presence of metastatic lymph nodes (N1) was identified in 76.1  % of cases. Among N1 cases, the most frequently involved lymph nodes were pancreaticoduodenal nodes (50  %), hepatoduodenal ligament nodes (21.7  %), superior mesenteric artery nodes (8.7  %), and anterior hepatic artery nodes (4.3  %). Overall, survival rates were 88.8, 40, and 18  % at 1, 3, and 5  years, respectively. Median survival was 31  months. By univariate analysis, only @entity5 grading and nodal metastasis were predictors of poor prognosis (p   <   0.05). These findings were not confirmed in multivariate analysis. CONCLUSIONS: This study shows that @entity1126 is a rare entity even if large surgical series are reviewed. @entity5 differentiation and nodal status have been confirmed as important prognostic factors. Pancreaticoduodenectomy remains the procedure of choice in order to obtain free surgical margins and in order to harvest the correct number of lymph nodes for a correct staging.
