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Intestinal-type and Pancreatobiliary-type Adenocarcinomas: How Does Ampullary Carcinoma Differ from Other Periampullary Malignancies?

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

Abstract

Background

Ampullary carcinomas typically have either intestinal or pancreatobiliary type of differentiation, histopathologically resembling carcinomas of its adjacent tissues (duodenum, bile duct, or pancreas). We evaluated whether the histologic type itself is more important for long-term survival than the fact that the tumor originated in the ampulla.

Methods

Microscopic slides from 207 consecutive pancreatoduodenectomies were reviewed (72 pancreatic, 46 biliary, 61 ampullary, and 28 duodenal adenocarcinomas; 76 intestinal type, 131 pancreatobiliary type). Tumor size, nodal involvement, margin involvement, degree of differentiation, vascular involvement, and perineural growth, as well as overall survival, were compared between different origins of the same histologic type.

Results

Intestinal-type ampullary adenocarcinomas had similar frequency of poor histopathologic factors compared to duodenal adenocarcinomas, and pancreatobiliary-type ampullary adenocarcinomas had similar frequency of poor histopathologic factors compared to pancreatobiliary-type biliary and pancreatic adenocarcinomas. Adjusting for tumor size and nodal involvement, there was no difference in long-term survival between patients with intestinal-type ampullary, duodenal, or biliary and pancreatic tumors (p = 0.79), and there was no difference in long-term survival between patients with pancreatobiliary-type ampullary, biliary, or pancreatic tumors (p = 0.41).

Conclusions

Long-term survival for patients with ampullary carcinomas equals pancreatic, biliary, and duodenal carcinomas when the same histologic type is compared. It can be questioned whether ampullary carcinomas should be regarded as a separate entity in classification of solid tumors. Clinical trials on adjuvant treatments for periampullary carcinomas should stratify by pancreatobiliary type versus intestinal type of histologic differentiation.

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Acknowledgment

The authors gratefully acknowledge all colleagues at the Department of Pathology, Oslo University Hospital, and Svetlana Tafjord in particular, for invaluable help in prospective classification of pancreatoduodenectomy resection specimens.

Conflict of interest

None declared.

Ethical Approval

The study was approved by the Regional Committee for Medical and Health Research Ethics for Southern Norway.

Author information

Authors and Affiliations

  1. Department of Oncology, The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway

    Arne Westgaard MD, PhD

  2. Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway

    Arne Westgaard MD, PhD, Ewa Pomianowska MD, Ole Petter F. Clausen MD, PhD & Ivar P. Gladhaug MD, PhD

  3. Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Rikshospitalet, Oslo, Norway

    Ewa Pomianowska MD & Ivar P. Gladhaug MD, PhD

  4. Department of Pathology, Oslo University Hospital, Rikshospitalet, Oslo, Norway

    Ewa Pomianowska MD & Ole Petter F. Clausen MD, PhD

Authors
  1. Arne Westgaard MD, PhD
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  2. Ewa Pomianowska MD
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  3. Ole Petter F. Clausen MD, PhD
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  4. Ivar P. Gladhaug MD, PhD
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Corresponding author

Correspondence to Arne Westgaard MD, PhD.

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Westgaard, A., Pomianowska, E., Clausen, O.P.F. et al. Intestinal-type and Pancreatobiliary-type Adenocarcinomas: How Does Ampullary Carcinoma Differ from Other Periampullary Malignancies?. Ann Surg Oncol 20, 430–439 (2013). https://doi.org/10.1245/s10434-012-2603-0

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  • DOI: https://doi.org/10.1245/s10434-012-2603-0

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