Pancreaticoduodenectomy for periampullary cancer in Sarawak :a 3-year survival analysis and factors affecting it

Abstract

Periampullary cancers incidence has been uprising worldwide which resulted in increasing morbidity and mortality. The distinct anatomy of that region often can give rise to different types of cancers. However, they are subjected to a common procedure – pancreaticoduodenectomy. The survivals after curative resection varies geographically and multiple cohort studies has shown to give different factors affecting the survival of periampullary cancers. Therefore, this study is to determine the overall survival and to identify the sociodemographic, peri-operative and histopathological factors affecting periampullary cancers after pancreaticoduodenectomy in Sarawak. Retrospective collected demographic, clinical features, peri-operative parameters histopathological features of all patient with periampullary cancers who underwent pancreaticoduodenectomy from January 2013 till June 2018. Overall survival and 3-year survival probability are determined using Kaplan-Meier curve. The affecting factors are analysed cox regression for univariate and multivariate analysis. A total of 56 patients with median for overall survival is 17.43 months (SD 2.86 months). The 3-year survival rate of this cohort is 14.0%. Iban (P = 0.006) and other minorities ethic (P = 0.005) in Sarawak shown to have a poor prognosis. Pre-operative biliary drainage is the only factor with significant difference (P<0.001, 95% CI 0.091 – 0.748) in univariate and multivariate analysis. Operating duration (P=0.006) and numbers of packed red blood cells transfused (P=0.018) are also significantly affecting the survivals after adjustment. Marginal involvement (P =0.024) and tumour types (P=0.055) are the histopathological factors with worst prognosis. The periampullary cancer survival rates in Sarawak was seen less comparable to other region. Ethnicity had been known to be a significant predictor in overall survival from the socio-demographic characteristic. Pre-operative biliary drainage, number of packed red cell blood transfusion and operative time were important peri-operative factors with significantly worsened the survival. Tumour types and marginal involvement were also strongly associated with poorer survival probability.