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 < 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.
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 < 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.
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: A Dorandeu; J L Raoul; F Siriser; N Leclercq-Rioux; M Gosselin; E D Martin; M P Ramée; B Launois Journal: Gut Date: 1997-03 Impact factor: 23.059
Authors: John T Miura; Thejus T Jayakrishnan; Albert Amini; Fabian M Johnston; Susan Tsai; Beth Erickson; Edward J Quebbeman; Kathleen K Christians; Douglas B Evans; T Clark Gamblin; Kiran K Turaga Journal: J Gastrointest Surg Date: 2014-08-27 Impact factor: 3.452
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Authors: Ibrahim Nassour; Alana Christie; Michael A Choti; John C Mansour; Rebecca M Minter; Patricio M Polanco; Mathew M Augustine; Matthew R Porembka; Xian-Jin Xie; Sam C Wang Journal: J Gastrointest Surg Date: 2018-03-15 Impact factor: 3.452