Analysis Of Prognostic Factors Of Vater Carcinoma After Laparoscopic Pancreatic Duodenectomy

Objective:pancreaticoduodenectomy is the first choice for the treatment of Vater ampullary carcinoma,and the prognosis after operation has naturally become a common concern.laparoscopic pancreaticoduodenectomy is gradually accepted and popularized because of small incision,clear vision,finer anatomy and less bleeding.The survival time of ampullary carcinoma is long,which is related to early detection and early operation.Chemotherapy also plays a key role.Because of the diversity of origin of ampullary carcinoma,different histopathological types and different prognosis of ampullary carcinoma,there is no unified chemotherapy scheme at present.This study was conducted to investigate the prognostic factors associated with laparoscopic pancreaticoduodenectomy Vater ampullary carcinoma,especially histopathological classification and chemotherapy.Methods.The clinicopathological and prognostic data of 47 cases diagnosed as ampullary adenocarcinoma in Zhejiang Provincial people’s Hospital from March 2015 to December 2019 were retrospectively analyzed.Overall survival probabilities were estimated using the Kaplan–Meier method and a Cox proportional hazards model.Results.47 patients underwent LPD(laparoscopic pancreatoduodenectomy).There were 31 males(66%)and 16 females(34%).The mean age was 65(34-91)years.The average BMI was 22.24(16.53-29.41)kg/m2.Tumor ≤ 2.5 cm 30 cases(63.8%), tumor >2.5 cm 17 cases(36.2%).T1 staging :9 cases(19.1 per cent);T2 staging :23cases(48.9%);T3 staging :12 cases(25.5%);T4 staging :3 cases(6.4%).T1 staging :9 cases(19.1 per cent);T2 staging :23 cases(48.9%);T3 staging :12 cases(25.5%);T4 staging :3 cases(6.4%).I-II period 36 cases(76.6%),III period 11 cases(23.6%).Histopathological classification: intestinal type 28 cases(59.6%)and pancreaticobiliary type 19 cases(40.4%).One and three-year overall survival rates after resection were 97.6 %,58.9% respectively.The median follow-up time was31.6 months(8.7-65.1).Median follow-up time of lymph node negative 29.8 months(8.7-65.1),median follow-up time for positive lymph nodes 25.3 months(13.8-50).Median follow-up time of intestinal type was 34.1 months(13.4-65.1),Pancreatic biliary type 20.3 months(8.7-52.3).The follow-up time of patients receiving chemotherapy was 30.2 months(11.5-65.1),and that of patients without chemotherapy was 27.8 months(8.7-62.9).The prognosis of patients with serum CA199>37 U/ml(HR =0.140,P=0.007.95%)was poor.The prognosis of patients with positive nerve invasion(HR=0.140,PHR=0.003.95% CI 0.039-0.508)was poor.Patients with pancreaticobiliary type(HR=6.633,PHR=0.006.95% CI1.735-25.362)were associated with short overall survival.Conclusions: laparoscopic pancreaticoduodenal therapy for Vater ampullary carcinoma is safe and feasible.Serum CA19-9>37 U/ml and nerve invasion positive Vater the prognosis of patients with ampullary carcinoma was poor.Histopathological classification affects the prognosis of ampullary carcinoma,and the survival time of pancreaticobiliary type is shorter than that of intestinal type.Postoperative chemotherapy has no effect on intestinal ampullary carcinoma and can prolong the survival of pancreaticobiliary ampullary carcinoma.