Treatment and overall survival of four types of non-metastatic periampullary cancer: nationwide population-based cohort study

HPB (Oxford). 2022 Sep;24(9):1433-1442. doi: 10.1016/j.hpb.2022.01.009. Epub 2022 Jan 23.


Background: Periampullary adenocarcinoma consists of pancreatic adenocarcinoma (PDAC), distal cholangiocarcinoma (DC), ampullary cancer (AC), and duodenal adenocarcinoma (DA). The aim of this study was to assess treatment modalities and overall survival by tumor origin.

Methods: Patients diagnosed with non-metastatic periampullary cancer in 2012-2018 were identified from the Netherlands Cancer Registry. OS was studied with Kaplan-Meier analysis and multivariable Cox regression analyses, stratified by origin.

Results: Among the 8758 patients included, 68% had PDAC, 13% DC, 12% AC, and 7% DA. Resection was performed in 35% of PDAC, 56% of DC, 70% of AC, and 59% of DA. Neoadjuvant and/or adjuvant therapy was administered in 22% of PDAC, 7% of DC, 7% of AC, and 12% of DA. Three-year OS was highest for AC (37%) and DA (34%), followed by DC (21%) and PDAC (11%). Adjuvant therapy was associated with improved OS among PDAC (HR = 0.62; 95% CI 0.55-0.69) and DC (HR = 0.69; 95% CI 0.48-0.98), but not AC (HR = 0.87; 95% CI 0.62-1.22) and DA (HR = 0.85; 95% CI 0.48-1.50).

Conclusion: This retrospective study identified considerable differences in treatment modalities and OS between the four periampullary cancer origins in daily clinical practice. An improved OS after adjuvant chemotherapy could not be demonstrated in patients with AC and DA.

MeSH terms

  • Adenocarcinoma* / pathology
  • Ampulla of Vater* / pathology
  • Ampulla of Vater* / surgery
  • Bile Duct Neoplasms* / pathology
  • Bile Ducts, Intrahepatic / pathology
  • Carcinoma, Pancreatic Ductal* / surgery
  • Chemotherapy, Adjuvant
  • Cholangiocarcinoma* / surgery
  • Cohort Studies
  • Common Bile Duct Neoplasms* / surgery
  • Duodenal Neoplasms* / surgery
  • Humans
  • Pancreatic Neoplasms* / pathology
  • Retrospective Studies