Factors influencing recurrence after curative resection for ampulla of Vater carcinoma.
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.
Park
Joon Seong
JS
Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.
Yoon
Dong Sup
DS
Kim
Kyung Sik
KS
Choi
Jin Sub
JS
Lee
Woo Jung
WJ
Chi
Hoon Sang
HS
Kim
Byong Ro
BR
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