title: Patterns and predictors of failure after curative resections of carcinoma of the ampulla of Vater.
abstract: BACKGROUND
  Curative resection does not always equate with long-term survival. The aim was to identify patterns and predictors of failure and independent factors of prognosis after curative resection.
  
  
  METHODS
  Sixty-six patients with ampullary carcinoma who underwent surgical intervention were reviewed. Fifty-nine patients underwent pancreaticoduodenectomy. Cox regression analysis, log-rank test, Fisher exact test, or chi(2) test was used.
  
  
  RESULTS
  No patient died as a result of surgery; major complications occurred in three, and the 5-year survival rate after curative resection (n = 55) was 52.6%. Significant survival predictors were preoperative serum carcinoembryonic antigen level; gross tumor appearance; tumor, node, and tumor node metastasis stage; and microscopic lymphatic vessel and venous invasion in the primary tumor. Multivariate analysis demonstrated that lymphatic vessel invasion, tumor, and tumor node metastasis stage were significant independent prognostic factors. No patient experienced locoregional failure alone; all 24 relapsed patients had distant failure, and six of them had both. The liver was the most frequent metastatic organ, followed by nodes, peritoneum, lung, and bone. The carcinoembryonic antigen and carbohydrate antigen levels and lymphatic vessel and venous invasion were significant predictors of distant failure, and the mean time to relapse was 13 (range, 0.7-33) months.
  
  
  CONCLUSIONS
  Curative resection is associated with significant survival; however, effective systemic adjuvant therapy is needed to prevent distant failure for patients with elevated carcinoembryonic antigen and carbohydrate antigen levels or positive lymphatic vessel or venous invasion. A 3-year follow-up period would be necessary to document relapses.
authors.affiliation: Departments of Surgery, Institute of Clinical Medicine, University of Tsukuba, Tsukuba-Shi, Japan. todorov@md.tsukuba.ac.jp
authors.forename: Takeshi
authors.initials: T
authors.lastname: Todoroki
authors.forename: Naoto
authors.initials: N
authors.lastname: Koike
authors.forename: Yukio
authors.initials: Y
authors.lastname: Morishita
authors.forename: Toru
authors.initials: T
authors.lastname: Kawamoto
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Ohkohchi
authors.forename: Junichi
authors.initials: J
authors.lastname: Shoda
authors.forename: Yoshiharu
authors.initials: Y
authors.lastname: Fukuda
authors.forename: Hideto
authors.initials: H
authors.lastname: Takahashi
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014670:Ampulla of Vater / Q000473:pathology / Q000601:surgery*; D014408:Biomarkers, Tumor / Q000097:blood; D016009:Chi-Square Distribution; D003138:Common Bile Duct Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D016577:Pancreaticoduodenectomy; D011183:Postoperative Complications; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D016019:Survival Analysis; D017211:Treatment Failure
chemical_list: D014408:Biomarkers, Tumor