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 of the pancreas and distal extrahepatic biliary tract, sometimes with most distal portion of the stomach. Adequate gross 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 here evaluated survival with a total of 65 pancreaticoduodenectomy specimens from 2006 to 2010 with reference to histological parameters like tumour type, site, size, grade, pT, pN, margin status and perineural invasion, and compared our results with international data. Patients were followed up and P-values were calculated regarding association 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 periampullary region (43.2%), with adenocarcinoma, NOS accounting for 72.4%. G2 was the most common grade (58.5%) and the most frequent pT was pT2 (52.4%), nearly half presenting with lymph node metastasis (47.7%). Significant associations (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 patients were 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 survival with pancreatico-duodenal lesions.