Carcinoma of the ampulla of Vater: long-term survival after surgical treatment.

Ninety-one patients were identified as having carcinoma arising from the ampulla of Vater. Radical pancreaticoduodenectomy, using either a standard or pylorus-preserving method, was performed in 69 consecutive patients over a 30-year period. Frequent clinical findings included jaundice (84%), a weight loss of more than 10% of the body weight (75%), abdominal pain (59%), chills and fever (52%), pruritus (48%) and a palpable gallbladder (38%). Acute pancreatitis was present in 10%. Postoperative mortality was 11.6%. Surgical mortality was 23.1% from 1962 to 1971 and 12.5% from 1972 to 1981, but was reduced to 6.3% from 1982 to 1991. Surgical mortality was primarily due to pancreaticojejunostomy leaks. The five-year survival rate was 52% and the 10-year rate was 50%. Radical pancreaticoduodenectomy for ampullary carcinoma has a low mortality and should remain the procedure of choice for ampullary carcinoma.