title: Pancreatoduodenectomy for tumors of Vater's ampulla: report on 94 consecutive patients.
abstract: Evaluation of prognostic factors of adenocarcinoma of Vater's ampulla is still a matter of debate. The aim of this study was to evaluate retrospectively factors that influence early and long-term outcomes in a 20-year single-institution experience on ampullary carcinoma. A total of 94 consecutive patients with ampullary carcinoma or adenoma with severe dysplasia were managed from 1981 to 2002. Among them, 64 underwent pancreatoduodenectomy, and the remaining 30 submitted to surgical (n = 5) or endoscopic (n = 25) palliative treatment. Demographic, clinical, and pathologic data were collected, and a comparison was made between patients who did or did not undergo resection. Standard statistical analyses were carried out in an attempt to establish a correlation between clinical variables, intraoperative and pathologic factors, and survival in patients with resection. A total of 85 (90.4%) patients had potentially resectable lesions due to the extent of the tumor, but only 64 (68%) underwent curative resection. The surgical morbidity rate was 34.3%. Postoperative mortality was 9.3%, with no deaths among the 38 more recently treated patients. Median survivals were 9 and 54 months for nonresected and resected patients, respectively. The overall 5-year survival was 64.4% for patients undergoing pancreatoduodenectomy. Survival was found to be significantly affected by resection, tumor size, tumor grade, and tumor infiltration. Patients with negative lymph nodes show a trend toward longer survival. In a multivariate analysis, only the depth of tumor infiltration influenced patient survival. Pancreatoduodenectomy is the treatment of choice for ampullary carcinoma and adenomas with high-grade dysplasia, with a good chance of long-term survival. Surgical resection remains the most important factor influencing outcome.
authors.affiliation: Department of Surgical Sciences, Digestive Surgery Unit, Catholic University-School of Medicine, Largo F. Vito 8, Rome 00168, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Di Giorgio
authors.forename: Sergio
authors.initials: S
authors.lastname: Alfieri
authors.forename: Fabio
authors.initials: F
authors.lastname: Rotondi
authors.forename: Francesco
authors.initials: F
authors.lastname: Prete
authors.forename: Dario
authors.initials: D
authors.lastname: Di Miceli
authors.forename: Marco Pericoli
authors.initials: MP
authors.lastname: Ridolfini
authors.forename: Fausto
authors.initials: F
authors.lastname: Rosa
authors.forename: Marcello
authors.initials: M
authors.lastname: Covino
authors.forename: Giovanni Battista
authors.initials: GB
authors.lastname: Doglietto
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014670:Ampulla of Vater; D003138:Common Bile Duct Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016577:Pancreaticoduodenectomy / Q000009:adverse effects / Q000379:methods; D012189:Retrospective Studies