Carcinoma of the ampulla of Vater: factors influencing long-term survival of 127 patients with resection.
BACKGROUND
The prognosis for patients with carcinoma of the ampulla of Vater is improved relative to other periampullary neoplasms. Identification of independent prognostic factors in ampullary carcinomas has been limited by the small number of tumors resected. The aim of the present study was to determine the clinicopathologic factors that influence long-term survival in patients with resected ampullary carcinoma.


METHODS
Clinicopathologic data were retrospectively reviewed for patients with ampullary carcinomas radically resected between March 1987 and September 2002. The correlation between clinicopathologic variables and survival of patients after resection was examined by the Kaplan-Meier method, the log-rank test, and Cox proportional hazards regression. Ampullary carcinomas were radically resected in 127 patients either by pancreaticoduodenectomy (n = 124) or local resection (n = 3).


RESULTS
Hospital mortality was 9.7%. The overall actuarial survival rates (including hospital deaths) at 1, 3, 5, and 10 years were 76.2%, 46.8%, 43.3%, and 35.7%, respectively. Factors that significantly influenced survival were lymph node status (P < 0.001), depth of tumor infiltration (P = 0.029), and TNM stage (P < 0.001) on univariate analysis. On multivariate analysis, both depth of infiltration and lymph node status were the independent determinants of survival after resection (P = 0.003, P = 0.005, respectively).


CONCLUSIONS
Carcinoma of the ampulla of Vater has a higher resectability rate and a much better survival rate than pancreatic cancer. Pancreaticoduodenectomy is the treatment of choice for this tumor. Long-term survival was independently influenced by the depth of tumor infiltration and lymph node metastasis.
Qiao
Qi-Lu
QL
Department of Surgery, First Hospital, Peking University, Beijing, 100034, China. qilugiao@hotmail.com
Zhao
Yi-Guo
YG
Ye
Mu-Lin
ML
Yang
Yin-Mo
YM
Zhao
Jian-Xun
JX
Huang
Yan-Ting
YT
Wan
Yuan-Lian
YL
D000230:Adenocarcinoma / Q000175:diagnosis / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D014670:Ampulla of Vater; D003138:Common Bile Duct Neoplasms / Q000175:diagnosis / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D016577:Pancreaticoduodenectomy; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D016019:Survival Analysis