Results of pancreaticoduodenectomy for ampullary carcinoma and analysis of prognostic factors for survival
Allema, J.H.; Reinders, M.E.; van Gulik, T.M.; van Leeuwen, D.J.; Verbeek, P.C.; de Wit, L.T.; Gouma, D.J.
Surgery 117(3): 247-253
1995
ISSN/ISBN: 0039-6060 PMID: 7878528 Document Number: 441563
Background: Results of pancreaticoduodenectomy for ampullary carcinoma were evaluated, and prognostic factors for survival were analyzed. Methods: During the period from 1984 to 1992 67 patients underwent subtotal or total pancreaticoduodenectomy for ampullary carcinoma. All clinicopathologic data and their influence on survival were studied. Results: Subtotal pancreaticoduodenectomy was performed in 62 of 67 patients with a mortality of 6% and a morbidity of 65%; the remaining five patients underwent total pancreaticoduodenectomy. Intraabdominal infection was the most important complication. Resection margins were tumor free in 75% of 67 patients. The overall 5-year survival was 50%. Survival was significantly influenced by the involvement of resection margins. After resection with involved margins 5-year survival was 15% and 60% after resection with free margins (p lt 0.001). Tumor size, lymph node involvement, and differentiation grade had limited and not significant influence on survival. Conclusions: Subtotal pancreaticoduodenectomy is the type of resection of first choice for ampullary carcinoma. Involvement of resection margins was the strongest Prognostic factor for survival. Patients with a tumor size larger than 2 cm, with lymph node involvement, or with a poorly differentiated tumor still had a 5-year survival rate greater than 40%. Patients with involved margins might be candidates for studies on adjuvant therapy.