BACKGROUND/ PURPOSE: The majority of surgeons agree that ampullary adenocarcinoma should be removed by partial pancreatoduodenectomy. Favoring extended resection, based on the uncertainty of the preoperative diagnosis and the higher probability of clear resection margins, we aimed to disclose the results of this surgical procedure in terms of postoperative morbidity and mortality, and to identify prognosticators of long-term survival. METHODS: We documented, prospectively, 25 consecutive patients with adenocarcinoma of the papilla of Vater in whom pylorus-preserving pancreatoduodenectomy was performed. Clinical data, pathology reports, International Union Against Cancer (UICC) tumor stage, postoperative morbidity, mortality, and long-term follow-up results were evaluated. The Kaplan-Meier method and log-rank test were applied for univariate analysis. The Cox proportional hazard model was used for multivariate analysis. RESULTS: Postoperative mortality was 4%, overall morbidity was 32%, and pancreas-associated morbidity was 8%. Mean survival time was 53.8 months. Tumor size, N status, UICC stage, lymphatic invasion, blood vessel infiltration, R0 resection, and age of patient at the cutoff of 70 years were independent predictors of survival on univariate analysis. Multivariate analysis, however, disclosed no independent predictors of prognosis. CONCLUSIONS: Pancreatoduodenectomy for ampullary carcinoma is reasonable in terms of postoperative morbidity and mortality. Tumor-related factors, R0 resection, and advanced age appeared as the main predictors of survival.
BACKGROUND/ PURPOSE: The majority of surgeons agree that ampullary adenocarcinoma should be removed by partial pancreatoduodenectomy. Favoring extended resection, based on the uncertainty of the preoperative diagnosis and the higher probability of clear resection margins, we aimed to disclose the results of this surgical procedure in terms of postoperative morbidity and mortality, and to identify prognosticators of long-term survival. METHODS: We documented, prospectively, 25 consecutive patients with adenocarcinoma of the papilla of Vater in whom pylorus-preserving pancreatoduodenectomy was performed. Clinical data, pathology reports, International Union Against Cancer (UICC) tumor stage, postoperative morbidity, mortality, and long-term follow-up results were evaluated. The Kaplan-Meier method and log-rank test were applied for univariate analysis. The Cox proportional hazard model was used for multivariate analysis. RESULTS: Postoperative mortality was 4%, overall morbidity was 32%, and pancreas-associated morbidity was 8%. Mean survival time was 53.8 months. Tumor size, N status, UICC stage, lymphatic invasion, blood vessel infiltration, R0 resection, and age of patient at the cutoff of 70 years were independent predictors of survival on univariate analysis. Multivariate analysis, however, disclosed no independent predictors of prognosis. CONCLUSIONS: Pancreatoduodenectomy for ampullary carcinoma is reasonable in terms of postoperative morbidity and mortality. Tumor-related factors, R0 resection, and advanced age appeared as the main predictors of survival.
Authors: Albert Amini; John T Miura; Thejus T Jayakrishnan; Fabian M Johnston; Susan Tsai; Kathleen K Christians; T Clark Gamblin; Kiran K Turaga Journal: HPB (Oxford) Date: 2014-11-14 Impact factor: 3.647
Authors: Serdar Balci; Olca Basturk; Burcu Saka; Pelin Bagci; Lauren M Postlewait; Takuma Tajiri; Kee-Taek Jang; Nobuyuki Ohike; Grace E Kim; Alyssa Krasinskas; Hyejeong Choi; Juan M Sarmiento; David A Kooby; Bassel F El-Rayes; Jessica H Knight; Michael Goodman; Gizem Akkas; Michelle D Reid; Shishir K Maithel; Volkan Adsay Journal: Ann Surg Oncol Date: 2015-03-18 Impact factor: 5.344
Authors: Jordan M Winter; John L Cameron; Kelly Olino; Joseph M Herman; Mechteld C de Jong; Ralph H Hruban; Christopher L Wolfgang; Frederic Eckhauser; Barish H Edil; Michael A Choti; Richard D Schulick; Timothy M Pawlik Journal: J Gastrointest Surg Date: 2010-02 Impact factor: 3.452