title: Combination therapy of resection and intraoperative radiation for patients with carcinomas of extrahepatic bile duct and ampulla of Vater: prognostic advantage over resection alone?
abstract: OBJECTIVE
  To investigate the therapeutic efficacy of intraoperative radiation for carcinomas of the bile duct and ampulla of Vater.
  
  
  METHODS
  Postoperative morbidity, mortality and survival of patients undergoing surgical resection of ampullary cancer (n = 19) and bile duct cancer (n = 28) were retrospectively compared between two groups with and without intraoperative radiation.
  
  
  RESULTS
  Background items (age, gender, preoperative laboratory data, operative time and bleeding volume, tumor stage) did not differ significantly between the two groups. The predominant postoperative complication was leakage of pancreatic juice, which occurred in similar rates in both groups. No significant differences were noted in the 3-year survival rates between the resection plus intraoperative radiation group and resection alone group (60.0% (n = 5) vs. 50.1% (n = 13) for ampullary cancer; 0% (n = 4) vs. 27.1% (n = 24) for bile duct cancer, respectively). The main causes of recurrence were distant metastasis for ampullary cancer and microscopic residue of carcinoma for bile duct cancer.
  
  
  CONCLUSIONS
  The combination of intraoperative radiation and resection may add no significant benefit to patients with ampullary and bile duct cancer when compared with resection alone.
authors.affiliation: Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan. kenji-n@med.kyushu-u.ac.jp
authors.forename: Kenji
authors.initials: K
authors.lastname: Nakano
authors.forename: Kazuo
authors.initials: K
authors.lastname: Chijiiwa
authors.forename: Takayuki
authors.initials: T
authors.lastname: Toyonaga
authors.forename: Junji
authors.initials: J
authors.lastname: Ueda
authors.forename: Yuji
authors.initials: Y
authors.lastname: Takamatsu
authors.forename: Masahiko
authors.initials: M
authors.lastname: Kimura
authors.forename: Katsumasa
authors.initials: K
authors.lastname: Nakamura
authors.forename: Koji
authors.initials: K
authors.lastname: Yamaguchi
authors.forename: Masao
authors.initials: M
authors.lastname: Tanaka
mesh_terms: D000368:Aged; D014670:Ampulla of Vater; D001650:Bile Duct Neoplasms / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D017734:Bile Ducts, Extrahepatic; D002423:Cause of Death; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D016577:Pancreaticoduodenectomy; D011379:Prognosis; D012189:Retrospective Studies; D016896:Treatment Outcome