الفهرس 
Impact of clinical and radiological predictors on short term outcome after whipple procedure
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Abstract
Pancreatic cancer (PC) is the fourth leading cause of cancer death in the U.S and resectable disease comprises only 15% to 20% of patients at presentation. Although there have been great advances in thesurgical management of pancreatic cancer and inthe understanding of the genetic and molecularevents that underlie pancreatic carcinogenesis, the5-year survival for all patients with the disease remains low.
R0 resection still offers the best chance for cure, however, some patients relapse shortly after the resection and exhibit a limited life span. Multimodality approach is currently used to improve survival rates.
This was a retrospective Cohort studyincluded 61 patients who underwent whipple’s procedure at NCI for pancreatic head adenocarcinoma and periampullary carcinoma, to evaluate overall survival of patients and determine clinical and radiological predictors that impact outcome parameters.
The mean age was 57 ± 10 years, ranging from 33 to 75 years. 43 patients (70.5%) were males and 18 patients (29.5%) were females. About 85% of patients underwent preoperative biliary drainage.
Intraoperatively, blood transfusion was given to 60 patients. In About 50% of patients, reconsruction was done by pancreatico-jejunostomy and the rest underwent pancreatico-39 patients had N0 stage (63.9%) and 22 patients (36.1%) had metastatic LNs. Lymphovascular invasion and perineural invasion were present in 29.5% of patients. About 82.0% (50 patients) had negative resection margins (R0) and the tumor grade was high in 77% of patients.
The median hospital stay was 13 days and the overall complications rate was (73.8%). The most frequent postoperative complications were wound infections (49.2%), followed by pancreatic leak (40%) and re-operation rate was approximately 8%. Delayed gastric emptying was observed in 8 cases (13.1%) and biliary leak was seen in 7 cases (11.5%).
The mean preoperative serum total bilirubin was 2.4, while median serum CEA was 2.8, the average tumor size by radiology was about 3 cm while on post-operative pathological analysis the average size was 3.8cm. The average LN count was 12.
5 patients (8.2%) receivedneoadjuvant treatment in the form of neoadjuvant chemotherapy, while adjuvant therapy was given in 40 patients (65.6%), 31 cases received adjuvant Chemotherapy and 8 cases received concurrent chemoradiotherapy.
The median follow up was 12 months, with range from 2 months to 42 months. The overall rate of 1st year survival after PD for PDAC was 77.1 %( 47/61).
Univariate analysis showed that: preoperative biliary drainage, post-operative pancreatic fistula (leak) and adjuvant treatment have statistically significant effect on overall survival.
On Multi variant analysis, post-operative pancreatic fistula (leak) and adjuvant treatment were the only predictors that has statistically significant effect on overall survival.