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. 1998 Jul;228(1):87–94. doi: 10.1097/00000658-199807000-00013

Factors predictive of survival in ampullary carcinoma.

J R Howe 1, D S Klimstra 1, R D Moccia 1, K C Conlon 1, M F Brennan 1
PMCID: PMC1191432  PMID: 9671071

Abstract

OBJECTIVE: To review the recent Memorial Sloan-Kettering Cancer Center experience with adenocarcinoma of the ampulla of Vater and to identify clinicopathologic factors that have an impact on patient survival. SUMMARY BACKGROUND DATA: The prognosis for patients with tumors of the ampulla of Vater is improved relative to other periampullary neoplasms. Identification of independent prognostic factors in ampullary tumors has been limited by small numbers of tumors and a lack of pathologic review. METHODS: Data were collected prospectively for patients presenting with periampullary carcinomas to the Memorial Sloan-Kettering Cancer Center between October 15, 1983 and June 30, 1995. The correlation between clinicopathologic variables and survival of ampullary carcinoma was tested by the Kaplan-Meier method and log-rank test, and Cox proportional hazards regression. Survival of patients with periampullary adenocarcinomas was compared by the Kaplan-Meier method. RESULTS: In 123 patients presenting with ampullary carcinoma, 101 tumors (82.1%) were resected. Factors significantly correlated with improved survival were resection (p < 0.01), and in resected tumors, negative nodes (p = 0.04) and margins (p = 0.02) independently predicted for improved survival. In periampullary tumors, the highest rates of resection and overall survival (median, 43.6 months) were found in ampullary carcinomas. CONCLUSIONS: Factors predictive of improved survival in ampullary carcinoma include resection, negative margins, and negative nodes. Improved overall survival in ampullary relative to periampullary adenocarcinoma is due in part to a significantly higher rate of resection.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Allema J. H., Reinders M. E., van Gulik T. M., van Leeuwen D. J., Verbeek P. C., de Wit L. T., Gouma D. J. Results of pancreaticoduodenectomy for ampullary carcinoma and analysis of prognostic factors for survival. Surgery. 1995 Mar;117(3):247–253. doi: 10.1016/s0039-6060(05)80197-7. [DOI] [PubMed] [Google Scholar]
  2. Branum G. D., Pappas T. N., Meyers W. C. The management of tumors of the ampulla of Vater by local resection. Ann Surg. 1996 Nov;224(5):621–627. doi: 10.1097/00000658-199611000-00006. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Chan C., Herrera M. F., de la Garza L., Quintanilla-Martinez L., Vargas-Vorackova F., Richaud-Patín Y., Llorente L., Uscanga L., Robles-Diaz G., Leon E. Clinical behavior and prognostic factors of periampullary adenocarcinoma. Ann Surg. 1995 Nov;222(5):632–637. doi: 10.1097/00000658-199511000-00005. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Chareton B., Coiffic J., Landen S., Bardaxoglou E., Campion J. P., Launois B. Diagnosis and therapy for ampullary tumors: 63 cases. World J Surg. 1996 Jul-Aug;20(6):707–712. doi: 10.1007/s002689900108. [DOI] [PubMed] [Google Scholar]
  5. Cohen J. R., Kuchta N., Geller N., Shires G. T., Dineen P. Pancreaticoduodenectomy. A 40-year experience. Ann Surg. 1982 May;195(5):608–617. doi: 10.1097/00000658-198205000-00010. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Conlon K. C., Klimstra D. S., Brennan M. F. Long-term survival after curative resection for pancreatic ductal adenocarcinoma. Clinicopathologic analysis of 5-year survivors. Ann Surg. 1996 Mar;223(3):273–279. doi: 10.1097/00000658-199603000-00007. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Connolly M. M., Dawson P. J., Michelassi F., Moossa A. R., Lowenstein F. Survival in 1001 patients with carcinoma of the pancreas. Ann Surg. 1987 Sep;206(3):366–373. doi: 10.1097/00000658-198709000-00015. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Crist D. W., Sitzmann J. V., Cameron J. L. Improved hospital morbidity, mortality, and survival after the Whipple procedure. Ann Surg. 1987 Sep;206(3):358–365. doi: 10.1097/00000658-198709000-00014. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Delcore R., Jr, Connor C. S., Thomas J. H., Friesen S. R., Hermreck A. S. Significance of tumor spread in adenocarcinoma of the ampulla of Vater. Am J Surg. 1989 Dec;158(6):593–597. doi: 10.1016/0002-9610(89)90201-8. [DOI] [PubMed] [Google Scholar]
  10. Hayes D. H., Bolton J. S., Willis G. W., Bowen J. C. Carcinoma of the ampulla of Vater. Ann Surg. 1987 Nov;206(5):572–577. doi: 10.1097/00000658-198711000-00003. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Herter F. P., Cooperman A. M., Ahlborn T. N., Antinori C. Surgical experience with pancreatic and periampullary cancer. Ann Surg. 1982 Mar;195(3):274–281. doi: 10.1097/00000658-198203000-00006. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Howe J. R., Klimstra D. S., Cordon-Cardo C., Paty P. B., Park P. Y., Brennan M. F. K-ras mutation in adenomas and carcinomas of the ampulla of vater. Clin Cancer Res. 1997 Jan;3(1):129–133. [PubMed] [Google Scholar]
  13. Jones B. A., Langer B., Taylor B. R., Girotti M. Periampullary tumors: which ones should be resected? Am J Surg. 1985 Jan;149(1):46–52. doi: 10.1016/s0002-9610(85)80008-8. [DOI] [PubMed] [Google Scholar]
  14. Kellum J. M., Clark J., Miller H. H. Pancreatoduodenectomy for resectable malignant periampullary tumors. Surg Gynecol Obstet. 1983 Oct;157(4):362–366. [PubMed] [Google Scholar]
  15. Knox R. A., Kingston R. D. Carcinoma of the ampulla of Vater. Br J Surg. 1986 Jan;73(1):72–73. doi: 10.1002/bjs.1800730129. [DOI] [PubMed] [Google Scholar]
  16. Lerut J. P., Gianello P. R., Otte J. B., Kestens P. J. Pancreaticoduodenal resection. Surgical experience and evaluation of risk factors in 103 patients. Ann Surg. 1984 Apr;199(4):432–437. doi: 10.1097/00000658-198404000-00010. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Martin F. M., Rossi R. L., Dorrucci V., Silverman M. L., Braasch J. W. Clinical and pathologic correlations in patients with periampullary tumors. Arch Surg. 1990 Jun;125(6):723–726. doi: 10.1001/archsurg.1990.01410180041008. [DOI] [PubMed] [Google Scholar]
  18. Matory Y. L., Gaynor J., Brennan M. Carcinoma of the ampulla of Vater. Surg Gynecol Obstet. 1993 Oct;177(4):366–370. [PubMed] [Google Scholar]
  19. Michelassi F., Erroi F., Dawson P. J., Pietrabissa A., Noda S., Handcock M., Block G. E. Experience with 647 consecutive tumors of the duodenum, ampulla, head of the pancreas, and distal common bile duct. Ann Surg. 1989 Oct;210(4):544–556. doi: 10.1097/00000658-198910000-00015. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Monson J. R., Donohue J. H., McEntee G. P., McIlrath D. C., van Heerden J. A., Shorter R. G., Nagorney D. M., Ilstrup D. M. Radical resection for carcinoma of the ampulla of Vater. Arch Surg. 1991 Mar;126(3):353–357. doi: 10.1001/archsurg.1991.01410270099016. [DOI] [PubMed] [Google Scholar]
  21. Mori K., Ikei S., Yamane T., Yamaguchi Y., Katsumori T., Shibata Y., Arai T. Pathological factors influencing survival of carcinoma of the ampulla of Vater. Eur J Surg Oncol. 1990 Jun;16(3):183–188. [PubMed] [Google Scholar]
  22. Nakase A., Matsumoto Y., Uchida K., Honjo I. Surgical treatment of cancer of the pancreas and the periampullary region: cumulative results in 57 institutions in Japan. Ann Surg. 1977 Jan;185(1):52–57. doi: 10.1097/00000658-197701000-00008. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Neoptolemos J. P., Talbot I. C., Carr-Locke D. L., Shaw D. E., Cockleburgh R., Hall A. W., Fossard D. P. Treatment and outcome in 52 consecutive cases of ampullary carcinoma. Br J Surg. 1987 Oct;74(10):957–961. doi: 10.1002/bjs.1800741025. [DOI] [PubMed] [Google Scholar]
  24. Nitecki S. S., Sarr M. G., Colby T. V., van Heerden J. A. Long-term survival after resection for ductal adenocarcinoma of the pancreas. Is it really improving? Ann Surg. 1995 Jan;221(1):59–66. doi: 10.1097/00000658-199501000-00007. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Robertson J. F., Imrie C. W., Hole D. J., Carter D. C., Blumgart L. H. Management of periampullary carcinoma. Br J Surg. 1987 Sep;74(9):816–819. doi: 10.1002/bjs.1800740921. [DOI] [PubMed] [Google Scholar]
  26. Roder J. D., Schneider P. M., Stein H. J., Siewert J. R. Number of lymph node metastases is significantly associated with survival in patients with radically resected carcinoma of the ampulla of Vater. Br J Surg. 1995 Dec;82(12):1693–1696. doi: 10.1002/bjs.1800821235. [DOI] [PubMed] [Google Scholar]
  27. Rose D. M., Hochwald S. N., Klimstra D. S., Brennan M. F. Primary duodenal adenocarcinoma: a ten-year experience with 79 patients. J Am Coll Surg. 1996 Aug;183(2):89–96. [PubMed] [Google Scholar]
  28. Schlippert W., Lucke D., Anuras S., Christensen J. Carcinoma of the papilla of Vater. A review of fifty-seven cases. Am J Surg. 1978 Jun;135(6):763–770. doi: 10.1016/0002-9610(78)90160-5. [DOI] [PubMed] [Google Scholar]
  29. Talamini M. A., Moesinger R. C., Pitt H. A., Sohn T. A., Hruban R. H., Lillemoe K. D., Yeo C. J., Cameron J. L. Adenocarcinoma of the ampulla of Vater. A 28-year experience. Ann Surg. 1997 May;225(5):590–600. doi: 10.1097/00000658-199705000-00015. [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. Tarazi R. Y., Hermann R. E., Vogt D. P., Hoerr S. O., Esselstyn C. B., Jr, Cooperman A. M., Steiger E., Grundfest S. Results of surgical treatment of periampullary tumors: a thirty-five-year experience. Surgery. 1986 Oct;100(4):716–723. [PubMed] [Google Scholar]
  31. Trede M., Schwall G., Saeger H. D. Survival after pancreatoduodenectomy. 118 consecutive resections without an operative mortality. Ann Surg. 1990 Apr;211(4):447–458. doi: 10.1097/00000658-199004000-00011. [DOI] [PMC free article] [PubMed] [Google Scholar]
  32. Tsao J. I., Rossi R. L., Lowell J. A. Pylorus-preserving pancreatoduodenectomy. Is it an adequate cancer operation. Arch Surg. 1994 Apr;129(4):405–412. doi: 10.1001/archsurg.1994.01420280081010. [DOI] [PubMed] [Google Scholar]
  33. WHIPPLE A. O. A reminiscence: pancreaticduodenectomy. Rev Surg. 1963 Jul-Aug;20:221–225. [PubMed] [Google Scholar]
  34. Walsh D. B., Eckhauser F. E., Cronenwett J. L., Turcotte J. G., Lindenauer S. M. Adenocarcinoma of the ampulla of Vater. Diagnosis and treatment. Ann Surg. 1982 Feb;195(2):152–157. doi: 10.1097/00000658-198202000-00005. [DOI] [PMC free article] [PubMed] [Google Scholar]
  35. Warren K. W., Choe D. S., Plaza J., Relihan M. Results of radical resection for periampullary cancer. Ann Surg. 1975 May;181(5):534–540. doi: 10.1097/00000658-197505000-00005. [DOI] [PMC free article] [PubMed] [Google Scholar]
  36. Whipple A. O., Parsons W. B., Mullins C. R. TREATMENT OF CARCINOMA OF THE AMPULLA OF VATER. Ann Surg. 1935 Oct;102(4):763–779. doi: 10.1097/00000658-193510000-00023. [DOI] [PMC free article] [PubMed] [Google Scholar]
  37. Yamaguchi K., Nagai E., Ueki T., Nishihara K., Tamaka M. Carcinoma of the ampulla of Vater. Aust N Z J Surg. 1993 Apr;63(4):256–262. doi: 10.1111/j.1445-2197.1993.tb00378.x. [DOI] [PubMed] [Google Scholar]

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