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

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. 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. 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. 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.