Radical surgical resection for carcinoid tumors of the ampulla.
Ampullary carcinoid tumors are extremely rare. The present study describes the clinicopathological features and outcomes for 10 ampullary carcinoid patients who underwent radical resection from 1998 to 2005. During this study period, 294 patients underwent pancreatoduodenectomy for ampullary neoplasms in our institution. The mean patient age was 58.0 +/- 13.4 years, and seven were male. Initial clinical manifestations were jaundice in four patients, nonspecific gastrointestinal symptoms in five, and completely asymptomatic in one. Standard pancreatoduodenectomy was performed in three patients, and pylorus-preserving pancreatoduodenectomy in seven, and there were no major complications. The mean tumor size and volume were 2.1 +/- 1.3 cm and 4.1 +/- 6.9 ml, respectively. Synaptophysin staining was positive in ten patients and chromogranin staining positive in eight. R0 resection was achieved in all ten patients. Overall and disease-free survival rates were 90 and 80% at 1 year, and 64 and 56% at 3 years, respectively. The liver was the most common site of initial metastasis after curative resection. Univariate analyses revealed that a maximal tumor diameter > or =2 cm and tumor extension beyond the ampulla were risk factors for tumor recurrence. In conclusion, while the majority of ampullary carcinoids are indolent, this tumor is associated with a relatively poor prognosis. We believe that radical resection, with the aim of complete tumor removal and cure, is the treatment of choice.
Hwang
Shin
S
Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, South Korea. shwang@amc.seoul.kr
Lee
Sung-Gyu
SG
Lee
Young-Joo
YJ
Han
Duck-Jong
DJ
Kim
Song-Cheol
SC
Kwon
Sea-Hyun
SH
Ryu
Je-Ho
JH
Park
Jung-Ik
JI
Lee
Hyo-Jun
HJ
Choi
Ga-Won
GW
Yu
Eun-Sil
ES
D000328:Adult; D000368:Aged; D014670:Ampulla of Vater; D002276:Carcinoid Tumor / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D002864:Chromogranins / Q000032:analysis; D003138:Common Bile Duct Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D006651:Histocytochemistry; D006801:Humans; D008113:Liver Neoplasms / Q000556:secondary; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D016577:Pancreaticoduodenectomy; D011379:Prognosis; D012307:Risk Factors; D015996:Survival Rate; D016708:Synaptophysin / Q000032:analysis
D002864:Chromogranins; D016708:Synaptophysin