title: Factors influencing recurrence after curative resection for ampulla of Vater carcinoma.
abstract: BACKGROUND
  Carcinoma of the ampulla of Vater has a relatively higher resection rate, lower recurrence rate, and more favorable prognosis than other malignant tumors of the periampullary region. Because of the relative low incidence of carcinoma of the ampulla of Vater, there have been few reports on the patterns and risk factors of recurrence after curative resection. The aim of this study was to evaluate the patterns and risk factors of recurrence after curative resection of ampulla of Vater carcinoma.
  
  
  METHODS
  Between January 1992 and December 2002, 102 patients received radical resection for ampulla of Vater carcinoma at Yonsei University Medical Center. Fifteen patients were excluded because of incomplete clinicopathologic data. Finally, 87 patients were reviewed and analyzed to assess predictors of tumor recurrence.
  
  
  RESULTS
  Among the 87 patients, 37 patients (42.5%) experienced recurrent disease. The mean length of time to recurrence was 29.3 +/- 35.3 months, and the most common sites of recurrence were the intra-abdominal organs: liver and loco-regional lymph nodes. The patients were divided into two groups: early recurrence (<or=18 months) and late recurrence (>18 months). In the early recurrence group, ulcer formation tumors and poorly differentiated tumors were more common in comparison with the late recurrence group. Lymph node metastasis was identified as an independent factor of tumor recurrence after curative resection for ampulla of Vater carcinoma.
  
  
  CONCLUSIONS
  Lymph node metastasis is the most important risk factor for recurrence after a curative resection. Also, the fact that a higher probability of recurrence is anticipated in cases of ulcer formation and poorly differentiated tumors, there exists a need for a close-up follow-up program.
authors.affiliation: Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Joon Seong
authors.initials: JS
authors.lastname: Park
authors.forename: Dong Sup
authors.initials: DS
authors.lastname: Yoon
authors.forename: Kyung Sik
authors.initials: KS
authors.lastname: Kim
authors.forename: Jin Sub
authors.initials: JS
authors.lastname: Choi
authors.forename: Woo Jung
authors.initials: WJ
authors.lastname: Lee
authors.forename: Hoon Sang
authors.initials: HS
authors.lastname: Chi
authors.forename: Byong Ro
authors.initials: BR
authors.lastname: Kim
mesh_terms: D000230:Adenocarcinoma / Q000556:secondary / Q000601:surgery*; D014670:Ampulla of Vater / Q000473:pathology / Q000601:surgery*; D003138:Common Bile Duct Neoplasms / Q000473:pathology / Q000601:surgery*; D004379:Duodenal Neoplasms / Q000556:secondary / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008207:Lymphatic Metastasis / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000601:surgery*; D009367:Neoplasm Staging; D010190:Pancreatic Neoplasms / Q000556:secondary / Q000601:surgery*; D016577:Pancreaticoduodenectomy; D011379:Prognosis; D015996:Survival Rate; D016896:Treatment Outcome