title: Presentation, treatment and outcome in patients with ampullary tumours.
abstract: BACKGROUND
  Ampullary tumours are relatively rare, and few large single-centre reports provide information on their treatment and outcome. The aim of this study was to analyse outcome and determine predictors of survival for patients with ampullary tumours treated in a specialist centre.
  
  
  METHODS
  Over an 11-year period, 561 patients were treated for periampullary tumours, 88 of whom had a histologically proven ampullary neoplasm. Prospectively gathered data were analysed to assess predictors of survival.
  
  
  RESULTS
  The overall resection rate was 92 per cent; there were no postoperative deaths. Median survival was 45.8 months for patients with resectable tumours and 8.0 months for those with irresectable disease (P < 0.001). On univariate analysis, age less than 70 years (P = 0.015) and a bilirubin level of 75 micromol/l or less (P = 0.012) favoured long-term survival. Among 70 patients who underwent cancer resection, factors associated with significantly worse long-term survival on univariate analysis included poorly differentiated tumour (P < 0.001), positive nodes (P < 0.001), perineural invasion (P = 0.001) and invasion of the pancreas (P = 0.018). Multivariate analysis identified positive nodes and bilirubin concentration as independent predictors of survival.
  
  
  CONCLUSIONS
  An aggressive surgical approach to ampullary tumours is justified by the low proportion of benign lesions, the absence of postoperative mortality and improved long-term survival.
authors.affiliation: Department of Surgery, Sherbrooke University, Sherbrooke, Quebec, Canada.
authors.forename: V
authors.initials: V
authors.lastname: Bettschart
authors.forename: M Q
authors.initials: MQ
authors.lastname: Rahman
authors.forename: F J F
authors.initials: FJ
authors.lastname: Engelken
authors.forename: K K
authors.initials: KK
authors.lastname: Madhavan
authors.forename: R W
authors.initials: RW
authors.lastname: Parks
authors.forename: O J
authors.initials: OJ
authors.lastname: Garden
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014670:Ampulla of Vater / Q000473:pathology / Q000601:surgery*; D003138:Common Bile Duct Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome