Prognostic outcomes of pancreaticoduodenectomy with lymph node dissection in pancreatic and periampullary adenocarcinoma; a retrospective cohort study

BACKGROUND: Pancreaticoduodenectomy (PD) is a key surgical treatment for pancreatic and periampullary malignancies, but morbidity remains a challenge. Lymph node dissection improves outcomes by removing cancerous tissue and preventing metastasis. This study aims to assess survival rates, recurrence, and other postoperative outcomes. METHODS: A retrospective cohort study was conducted on 390 patients who underwent PD with for pancreatic and periampullary adenocarcinoma between 2019 and 2023 at a single tertiary center. Non-adenocarcinoma histologies were excluded to ensure a homogeneous cohort. Follow-up data were available for 299 patients (76.7%), collected through hospital records and structured telephone interviews. Primary outcomes were overall survival, recurrence, and postoperative morbidity. Statistical analyses included Kaplan-Meier survival estimation, Cox proportional hazards modeling, and recurrence-free survival analysis. Fine-Gray competing risk regression and a prognostic nomogram were used for further risk stratification. RESULTS: Among the 390 patients, the median overall survival was 3.5 years. The 1- and 3-year survival rates were 69.2% and 50.6%, respectively. The 5-year survival estimate (41.0%) should be considered preliminary, as it is based on extrapolation from immature follow-up data; mature 5-year outcomes require extended observation beyond the current study period. Multivariable analysis identified several key predictors of mortality: age ≥ 65 years (HR: 2.55, p < 0.001), pancreatic tumor origin (HR: 1.58, p = 0.009), positive lymph node status (HR: 2.37, p < 0.001), and fewer than 12 nodes removed (HR: 1.53, p = 0.018). Adjuvant chemotherapy reduced the risk of death (HR: 0.68, p = 0.033). Recurrence-free survival demonstrated the steepest decline during the first 36 months postoperatively. CONCLUSION: Lymph node status, chemotherapy, and tumor origin are crucial for predicting survival after PD. Proper lymph node evaluation and adjuvant chemotherapy are essential for improving outcomes.