Morphology, TNM Staging and Survival with Pancreaticoduodenectomy Specimens received at Shaukat Khanum Memorial Cancer Hospital and Research Centre, Pakistan

Background: Whipple specimens consists of duodenum from the pylorus to the ligament of Treitz, the head ofthe pancreas and distal extrahepatic biliary tract, sometimes with most distal portion of the stomach. Adequategross handling of the specimen and assessment of histological variables is of prognostic importance.
Methods:At the Pathology Department of Shaukat Khanum Memorial Cancer Hospital and Research Centre, we hereevaluated survival with a total of 65 pancreaticoduodenectomy specimens from 2006 to 2010 with reference tohistological parameters like tumour type, site, size, grade, pT, pN, margin status and perineural invasion, andcompared our results with international data. Patients were followed up and P-values were calculated regardingassociation between survival and prognostic factors, Kaplan-meier survival curves also being plotted.
Results:Most of the patients were males (60%), with a mean age of 50 yrs. The most frequent site was periampullaryregion (43.2%), with adenocarcinoma, NOS accounting for 72.4%. G2 was the most common grade (58.5%) andthe most frequent pT was pT2 (52.4%), nearly half presenting with lymph node metastasis (47.7%). Significantassociations (p<0.05) were noted for survival with grade, pT, pN, margins, tumor size and perineural invasion,but not tumor site, tumor type and age. Kaplan-Meier curve revealed that at end of 1 month, 70% of the patientswere alive, this decreasing to 40%, 15% and 5% and at the end of 6 months, 1 year and 2 years.
Conclusion:Tumor size, type, pathologic T and N staging, margins and perineural invasion are directly related to survivalwith pancreatico-duodenal lesions.