Prognosis of cancer of the duodenal papilla of Vater in relation to clinicopathological tumor extension.

Between 1981 and 1991, cancer of the duodenal papilla of Vater was surgically treated in 26 out of 28 cases (92%). Twenty-five patients underwent pancreatoduodenectomy and one had a total pancreatectomy. There were no surgical or hospital deaths in these 26 patients. Their five-year cumulative survival rate was 52%. In the 26 patients, we submitted the surgically removed tissue specimens to histopathological examination and performed immunohistochemical analysis using antibodies against various gastrointestinal cancer antigens. We analyzed the results in relation to the prognosis. The histological stage of the cancer was found to correlate with the prognosis. Patients having cancer invading the pancreatic parenchyma had a particularly poor prognosis. Some exhibited perineural invasion. Patients with cancer invasion into the pancreatic parenchyma frequently showed a grade II positive response to immunohistochemical staining, with a staining pattern similar to that of pancreatic duct cell carcinoma. In patients in whom cancer invasion did not extend beyond the sphincter of Oddi, the five-year survival rate was 100%. Therefore, cancer of the papilla of Vater which has not invaded beyond the the sphincter of Oddi, may be regarded as early cancer of the papilla of Vater. These results indicate that surgical procedures for cancer of the papilla of Vater should be selected on the basis of an accurate preoperative evaluation of cancer invasion by various imaging techniques (chiefly endoscopic ultrasonography), and that the treatment of advanced cancer of the papilla of Vater requires not only extensive surgical resection but also a more effective multi-disciplinary treatment plan.