Skip to main content

Advertisement

SpringerLink
Log in

Predictors for Patterns of Failure after Pancreaticoduodenectomy in Ampullary Cancer

  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Ampullary cancer has the best prognosis in periampullary malignancy but unpredicted early recurrence after resection is frequent. The current study tried to find the predictors for recurrence to be used as determinative for postoperative adjuvant therapy.

Methods

Information was collected from patients who underwent pancreaticoduodenectomy with regional lymphadenectomy for ampullary cancer in high-volume hospitals between January 1989 and April 2005. Recurrence patterns and survival rates were calculated and predictors were identified.

Results

A total of 135 eligible patients were included. The 30-day operative mortality was 3%. Median followup for relapse-free patients was 52 months. Disease recurred in 57 (42%) patients, including 31 liver metastases, 26 locoregional recurrences, 9 peritoneal carcinomatoses, 7 bone metastases, and 6 other sites. Pancreatic invasion (P = 0.04) and tumor size (P = 0.05) were the predictors for locoregional recurrence, while lymph node metastasis was the sole predictor for liver metastasis (P = 0.01). The 5-year disease-specific survival rate was 45.7%; 77.7% for stage I, 28.5% for stage II, and 16.5% for stage III; and 63.7% for node-negative versus 19.1% for node-positive patients. Pancreatic invasion and lymph node involvement were both predictors for survival of patients with ampullary cancer.

Conclusion

Pancreaticoduodenectomy with regional lymphadenectomy is adequate for early-stage ampullary cancer but a dismal outcome can be predicted in patients with lymph node metastasis and pancreatic invasion. Lymph node metastasis and pancreatic invasion can be used to guide individualized, risk-oriented adjuvant therapy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig .1.
Fig. 2.
Fig. 3.
Fig. 4.

Similar content being viewed by others

References

  1. Yamaguchi K, Enjoji M. Carcinoma of the ampulla of Vater: a clinicopathologic study and pathologic staging of 109 cases of carcinoma and 5 cases of adenoma. Cancer 1987; 59:506-515

    Article  PubMed  CAS  Google Scholar 

  2. Nakase A, Matsumoto Y, Uchida K, et al. Surgical treatment of cancer of the pancreas and the periampullary region: cumulative results in 57 institutions in Japan. Ann Surg 1977; 185(1):52-57

    Article  PubMed  CAS  Google Scholar 

  3. Warren KW, Choe DS, Plaza J, et al. Results of radical resection for periampullary cancer. Ann Surg 1975; 181(5):534-540

    Article  PubMed  CAS  Google Scholar 

  4. Talamini MA, Moesinger RC, Pitt HA, et al. Adenocarcinoma of the ampulla of Vater: a 28-year experience. Ann Surg 1997; 225(5):590-600

    Article  PubMed  CAS  Google Scholar 

  5. Yoon YS, Kim SW, Park SJ, et al. Clinicopathologic analysis of early ampullary cancers with a focus on the feasibility of ampullectomy. Ann Surg 2005; 242(1):92-100

    Article  PubMed  Google Scholar 

  6. Böttger TC, Boddin J, Heintz A, et al. Clinicopathologic study for the assessment of resection for ampullary carcinoma. World J Surg 1997; 21:379-383

    Article  PubMed  Google Scholar 

  7. Roder JD, Schneider PM, Stein HJ, et al. Number of lymph node metastases is significantly associated with survival in patients with radically resected carcinoma of the ampulla of Vater. Br J Surg 1995; 82:1693-1696

    Article  PubMed  CAS  Google Scholar 

  8. Bakkevold KE, Arnesjø B, Dahl O, et al. Adjuvant combination chemotherapy (AMF) following radical resection of carcinoma of the pancreas and papilla of Vater- results of a controlled, prospective randomized multicentre study. Eur J Cancer 1993; 29A(5):698-703

    Article  PubMed  CAS  Google Scholar 

  9. Sikora SS, Balachandran P, Dimri K, et al. Adjuvant chemo-radiotherapy in ampullary cancers. Eur J Surg Oncol 2005; 31: 158–163

    Article  PubMed  CAS  Google Scholar 

  10. Lin PW, Lee JC, Lee PC, Chang TW, Hung CJ, Chang YC. A simple, secure and universal pancreaticojejunostomy following pancreaticoduodenectomy. HPB Surg 1997; 10:305-310

    Article  PubMed  CAS  Google Scholar 

  11. Lin PW, Lin YJ. Prospective randomized comparison between pylorus-preserving and standard pancreaticoduodenectomy. Br J Surg 1999; 86:603-607

    Article  PubMed  CAS  Google Scholar 

  12. Shan YS, Sy ED, Lin PW. Role of somatostatin in the prevention of pancreatic stump-related morbidity following elective pancreaticoduodenectomy in high-risk patients and elimination of surgeon-related factors: prospective, randomized, controlled trail. World J Surg 2003; 27:709-714

    Article  PubMed  Google Scholar 

  13. Shan YS, Hsieh YH, Sy ED, Lin PW. Delayed gastric emptying after pylorus-preserving pancreaticoduodenectomy. J Formos Med Assoc 2004; 103:767-772

    PubMed  Google Scholar 

  14. Greene FL, Page DL, Fleming ID, et al. (2002). AJCC Cancer Staging Manual, 6th ed. New York: Springer, pp 151–153

    Google Scholar 

  15. Todoroki T, Koike N, Morishita Y, et al. Patterns and predictors of failure after curative resections of carcinoma of the ampulla of Vater. Ann Surg Oncol 2003; 10(10):1176-1183

    Article  PubMed  Google Scholar 

  16. Lee JH, Whittington R, Williams NN, et al. Outcome of pancreaticoduodenectomy and impact of adjuvant therapy for ampullary carcinomas. Int J Radiat Oncol Biol Phys 2000; 47(4):945-953

    Article  PubMed  CAS  Google Scholar 

  17. Delcore R, Connor CS, Thomas JH, et al. Significance of tumor spread in adenocarcinoma of the ampulla of Vater. Am J Surg 1989; 158:593-597

    Article  PubMed  Google Scholar 

  18. Beger HG, Treitschke F, Gansauge F, et al. Tumor of the ampulla of Vater: experience with local or radical resection in 171 consecutively treated patients. Arch Surg 1999; 134:526-532

    Article  PubMed  CAS  Google Scholar 

  19. Monson JR, Donohue JH, McEntee GP, et al. Radical resection for carcinoma of the ampulla of Vater. Arch Surg 1991; 126:353-357

    PubMed  CAS  Google Scholar 

  20. Shirai Y, Tsukada K, Ohtani T, et al. Carcinoma of the ampulla of Vater: is radical lymphadenectomy beneficial to patients with nodal disease? J Surg Oncol 1996; 61:190-194

    Article  PubMed  CAS  Google Scholar 

  21. Matory YL, Gaynor J, Brennan M. Carcinoma of the ampulla of Vater. Surg Gynecol Obstet 1993; 177:366-370

    PubMed  CAS  Google Scholar 

  22. Allema JH, Reinders ME, van Gulik TM, et al. Results of pancreaticoduodenectomy for ampullary carcinoma and analysis of prognostic factors for survival. Surgery 1995; 117:247-253

    Article  PubMed  CAS  Google Scholar 

  23. Yeo CJ, Sohn TA, Cameron JL, et al. Periampullary adenocarcinoma: analysis of 5-year survivors. Ann Surg 1998; 227(6):821-831

    Article  PubMed  CAS  Google Scholar 

  24. Akwari OE, van Heerden JA, Adson MA, et al. Radical pancreatoduodenectomy for cancer of the papilla of Vater. Arch Surg 1977; 112:451-456

    PubMed  CAS  Google Scholar 

  25. Williams JA, Cubilla A, Maclean BJ, et al. Twenty-two year experience with periampullary carcinoma at Memorial Sloan-Kettering Cancer Center. Am J Surg 1979; 138:662-665

    Article  PubMed  CAS  Google Scholar 

  26. Kayahara M, Nagakawa T, Ohta T, et al. Surgical strategy for carcinoma of the papilla of Vater on the basis of lymphatic spread and mode of recurrence. Surgery 1997; 121:611-617

    Article  PubMed  CAS  Google Scholar 

  27. Howe JR, Klimstra DS, Moccia RD, et al. Factors predictive of survival in ampullary carcinoma. Ann Surg 1998; 228(1):87-94

    Article  PubMed  CAS  Google Scholar 

  28. Schmidt CM, Powell ES, Yiannoutsos CT, et al. Pancreaticoduodenectomy: a 20-year experience in 516 patients. Arch Surg 2004; 139:718-727

    Article  PubMed  Google Scholar 

  29. Brown KM, Tompkins AJ, Yong S, et al. Pancreaticoduodenectomy is curative in the majority of patients with node-negative ampullary cancer. Arch Surg 2005; 140:529-533

    Article  PubMed  Google Scholar 

  30. Nakano K, Chijiiwa K, Toyonaga T, et al. Combination therapy of resection and intraoperative radiation for patients with carcinomas of extrahepatic bile duct and ampulla of Vater: prognostic advantage over resection alone? Hepatogastroenterology 2003; 50:928-933

    PubMed  Google Scholar 

  31. Willett CG, Warshaw AL, Convery K, et al. Patterns of failure after pancreaticoduodenectomy for ampullary carcinoma. Surg Gynecol Obstet 1993; 176:33-38

    PubMed  CAS  Google Scholar 

  32. Mehta VK, Fisher GA, Ford JM, et al. Adjuvant chemoradiotherapy for “unfavorable” carcinoma of the ampulla of Vater: preliminary report. Arch Surg 2001; 136:65-69

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138, Sheng-Li Road, Tainan, 70428, Taiwan (ROC)

    Hui-Ping Hsu MD, Yan-Shen Shan MD, PhD & Pin-Wen Lin MD

  2. Department of Surgery, Tainan Municipal Hospital, Tainan, Taiwan

    Ta-Ming Yang MD

  3. Department of Emergency Medicine, The Johns Hopkins University School of Medicine, 1830 E. Monument Street, Suite 6-100, Baltimore, Maryland, 21205, USA

    Yu-Hsiang Hsieh PhD

Authors
  1. Hui-Ping Hsu MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ta-Ming Yang MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yu-Hsiang Hsieh PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yan-Shen Shan MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Pin-Wen Lin MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yan-Shen Shan MD, PhD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hsu, HP., Yang, TM., Hsieh, YH. et al. Predictors for Patterns of Failure after Pancreaticoduodenectomy in Ampullary Cancer. Ann Surg Oncol 14, 50–60 (2007). https://doi.org/10.1245/s10434-006-9136-3

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-006-9136-3

Keywords

Search

Navigation