Histopathological Features of Whipple Pancreaticoduodenectomy in Sudan: A Single-center Experience

Background: Periampullary tumors (PATs) are rare and Whipple pancreaticoduodenectomy is the commonest surgical approach for its management. The aim of this study was to analyze the histopathological features of Whipple-resected periampullary tumors in Sudanese patients.  
Methods: This retrospective descriptive study included 62 cases of Whipple resection seen in a center in Khartoum, Sudan from January 2016 to June 2021. The specimens were assessed for nine features of the tumor: site of the tumor (whether within the periampullary region), size of the tumor, histological type of the tumor, grade, perineural invasion, lymph vascular invasion, surgical margin status, lymph node metastasis status, and the pathological stage (pTNM).
Results: In total, 62 cases, 40 (64.5%) males and 22 (35.5%) females, were included. Age ranged from 20 to 90 years with a mean age of 56.08 years (±12.98 SD). Of the 62 cases, 58 were malignant (93.5%), while 4 cases were benign (6.5%). The pancreas was the commonest site for malignant tumors (53.4%), followed by the ampulla (24.1%), duodenum (15.5%), and distal common bile duct tumors (DCBD) (7%). The maximum tumor size was 8 cm, and the number of lymph nodes resected ranged from 3 to 33. Pancreatic ductal adenocarcinomas (PDACs) showed the highest percentage of perineural (62.1%) and lymphovascular (55.2%) invasions, and a positive margin was seen in four cases. The most common tumor stage was pT3pN1pMx.
Conclusion: PATs in the Sudanese population showed histological diversity regarding subtyping, grading, and staging. Further studies involving molecular prognostic features will support improving patient management.