Abstract
The aim of this study was to identify prognostic factors in patients undergoing pancreatoduodenectomy with lymphadenectomy for ampullary carcinoma. The records of 46 consecutive patients with ampullary carcinoma who underwent pancreatoduodenectomy from 1988 through 2006 were retrospectively reviewed. A 98% rate of potentially curative (R0) resection was achieved. There was no 30-day mortality. Overall 5-year survival rate was 64%. Univariate analysis revealed that T3 and T4 tumor (i.e., pancreatic parenchymal invasion) (P < 0.001), lymph node metastasis (P = 0.01), and perineural invasion (P < 0.001) were significant predictors of poor prognosis. Furthermore, perineural invasion was found to be a significant independent predictor of poor prognosis by multivariate analysis (P = 0.024). Pancreatoduodenectomy with lymphadenectomy for ampullary carcinoma is a safe surgical procedure with an acceptable cure rate. The presence of perineural invasion may be useful for predicting poor prognosis in patients with ampullary carcinoma who undergo potentially curative resection.
Similar content being viewed by others
References
Howe JR, Klimstra DS, Moccia RD, Conlon KC, Brennan MF (1998) Factors predictive of survival in ampullary carcinoma. Ann Surg 228(1):87–94
Yeo CJ, Sohn TA, Cameron JL, Hruban RH, Lillemoe KD, Pitt HA (1998) Periampullary adenocarcinoma: analysis of 5-year survivors. Ann Surg 227(6):821–831
Talamini MA, Moesinger RC, Pitt HA, Sohn TA, Hruban RH, Lillemoe KD, Yeo CJ, Cameron JL (1997) Adenocarcinoma of the ampulla of Vater. A 28-year experience. Ann Surg 225(5):590–600
Beger HG, Treitschke F, Gansauge F, Harada N, Hiki N, Mattfeldt T (1999) Tumor of the ampulla of Vater: experience with local or radical resection in 171 consecutively treated patients. Arch Surg 134(5):526–532
Todoroki T, Koike N, Morishita Y, Kawamoto T, Ohkohchi N, Shoda J, Fukuda Y, Takahashi H (2003) Patterns and predictors of failure after curative resections of carcinoma of the ampulla of Vater. Ann Surg Oncol 10(10):1176–1183
Brown KM, Tompkins AJ, Yong S, Aranha GV, Shoup M (2005) Pancreaticoduodenectomy is curative in the majority of patients with node-negative ampullary cancer. Arch Surg 140(6):529–532
Di Giorgio A, Alfieri S, Rotondi F, Prete F, Di Miceli D, Ridolfini MP, Rosa F, Covino M, Doglietto GB (2005) Pancreatoduodenectomy for tumors of Vater’s ampulla: report on 94 consecutive patients. World J Surg 29(4):513–518
Kim RD, Kundhal PS, McGilvray ID, Cattral MS, Taylor B, Langer B, Grant DR, Zogopoulos G, Shah SA, Greig PD, Gallinger S (2006) Predictors of failure after pancreaticoduodenectomy for ampullary carcinoma. J Am Coll Surg 202(1):112–119
Qiao QL, Zhao YG, Ye ML, Yang YM, Zhao JX, Huang YT, Wan YL (2007) Carcinoma of the ampulla of Vater: factors influencing long-term survival of 127 patients with resection. World J Surg 31(1):137–143
de Castro SM, van Heek NT, Kuhlmann KF, Busch OR, Offerhaus GJ, van Gulik TM, Obertop H, Gouma DJ (2004) Surgical management of neoplasms of the ampulla of Vater: local resection or pancreatoduodenectomy and prognostic factors for survival. Surgery 136(5):994–1002
Roder JD, Schneider PM, Stein HJ, Siewert JR (1995) Number of lymph node metastases is significantly associated with survival in patients with radically resected carcinoma of the ampulla of Vater. Br J Surg 82(12):1693–1696
Sakata J, Shirai Y, Wakai T, Yokoyama N, Sakata E, Akazawa K, Hatakeyama K (2007) Number of positive lymph nodes independently affects long-term survival after resection in patients with ampullary carcinoma. Eur J Surg Oncol 33(3):346–351
Nakai T, Koh K, Kawabe T, Son E, Yoshikawa H, Yasutomi M (1997) Importance of microperineural invasion as a prognostic factor in ampullary carcinoma. Br J Surg 84(10):1399–1401
Duffy JP, Hines OJ, Liu JH, Ko CY, Cortina G, Isacoff WH, Nguyen H, Leonardi M, Tompkins RK, Reber HA (2003) Improved survival for adenocarcinoma of the ampulla of Vater: fifty-five consecutive resections. Arch Surg 138(9):941–950
Sobin LH, Wittekind C (eds) (2002) International Union Against Cancer (UICC): TNM classification of malignant tumors, 6th edn. Wiley-Liss, New York
Japanese Society of Biliary Surgery (JSBS) (2003) Classification of biliary tract carcinoma, 2nd English edn. Kanehara, Tokyo
Yeo CJ, Cameron JL, Sohn TA, Lillemoe KD, Pitt HA, Talamini MA, Hruban RH, Ord SE, Sauter PK, Coleman J, Zahurak ML, Grochow LB, Abrams RA (1997) Six hundred fifty consecutive pancreaticoduodenectomies in the 1990s: pathology, complications, and outcomes. Ann Surg 226(3):248–260
Klempnauer J, Ridder GJ, Pichlmayr R (1995) Prognostic factors after resection of ampullary carcinoma: multivariate survival analysis in comparison with ductal cancer of the pancreatic head. Br J Surg 82(12):1686–1691
Sperti C, Pasquali C, Piccoli A, Sernagiotto C, Pedrazzoli S (1994) Radical resection for ampullary carcinoma: long-term results. Br J Surg 81(5):668–671
Allema JH, Reinders ME, van Gulik TM, van Leeuwen DJ, Verbeek PC, de Wit LT, Gouma DJ (1995) Results of pancreaticoduodenectomy for ampullary carcinoma and analysis of prognostic factors for survival. Surgery 117(3):247–253
Nagakawa T, Mori K, Nakano T, Kadoya M, Kobayashi H, Akiyama T, Kayahara M, Ohta T, Ueno K, Higashino Y et al (1993) Perineural invasion of carcinoma of the pancreas and biliary tract. Br J Surg 80(5):619–621
Nakao A, Harada A, Nonami T, Kaneko T, Takagi H (1996) Clinical significance of carcinoma invasion of the extrapancreatic nerve plexus in pancreatic cancer. Pancreas 12(4):357–361
Takahashi T, Ishikura H, Motohara T, Okushiba S, Dohke M, Katoh H (1997) Perineural invasion by ductal adenocarcinoma of the pancreas. J Surg Oncol 65(3):164–170
Hirai I, Kimura W, Ozawa K, Kudo S, Suto K, Kuzu H, Fuse A (2002) Perineural invasion in pancreatic cancer. Pancreas 24(1):15–25
Branum GD, Pappas TN, Meyers WC (1996) The management of tumors of the ampulla of Vater by local resection. Ann Surg 224(5):621–627
Clary BM, Tyler DS, Dematos P, Gottfried M, Pappas TN (2000) Local ampullary resection with careful intraoperative frozen section evaluation for presumed benign ampullary neoplasms. Surgery 127(6):628–633
Yoon YS, Kim SW, Park SJ, Lee HS, Jang JY, Choi MG, Kim WH, Lee KU, Park YH (2005) Clinicopathologic analysis of early ampullary cancers with a focus on the feasibility of ampullectomy. Ann Surg 242(1):92–100
Rattner DW, Fernandez-del Castillo C, Brugge WR, Warshaw AL (1996) Defining the criteria for local resection of ampullary neoplasms. Arch Surg 131(4):366–371
Cannon ME, Carpenter SL, Elta GH, Nostrant TT, Kochman ML, Ginsberg GG, Stotland B, Rosato EF, Morris JB, Eckhauser F, Scheiman JM (1999) EUS compared with CT, magnetic resonance imaging, and angiography and the influence of biliary stenting on staging accuracy of ampullary neoplasms. Gastrointest Endosc 50(1):27–33
Shoup M, Hodul P, Aranha GV, Choe D, Olson M, Leya J, Losurdo J (2000) Defining a role for endoscopic ultrasound in staging periampullary tumors. Am J Surg 179(6):453–456
Asbun HJ, Rossi RL, Munson JL (1993) Local resection for ampullary tumors. Is there a place for it? Arch Surg 128(5):515–520
Klein P, Reingruber B, Kastl S, Dworak O, Hohenberger W (1996) Is local excision of pT1-ampullary carcinomas justified? Eur J Surg Oncol 22(4):366–371
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Sudo, T., Murakami, Y., Uemura, K. et al. Prognostic Impact of Perineural Invasion Following Pancreatoduodenectomy With Lymphadenectomy for Ampullary Carcinoma. Dig Dis Sci 53, 2281–2286 (2008). https://doi.org/10.1007/s10620-007-0117-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10620-007-0117-6