title: Usefulness of follow-up after pancreatoduodenectomy for carcinoma of the ampulla of Vater.
abstract: BACKGROUND
  The prognosis for carcinoma of the ampulla of Vater (CAV) is better than for pancreatic cancer. The 5-year survival median rate after resection of CAV is 45%, but late recurrences remain possible. Several survival factors have been identified (lymph nodes, perineural invasion), but few data are available on the type of recurrences, their impact and their management.
  
  
  METHODS
  A total of 41 patients treated by pancreatoduodenectomy (PD) for CAV from 1980 to 2003 were studied retrospectively. Patient selection, long-term survival recurrence rate and recurrence treatment were reviewed. Univariate and multivariate proportional hazards analysis were conducted on this series.
  
  
  RESULTS
  The mean follow-up was 48 months. Five-year survival was 62.8%. Eleven patients had recurrences (6-67 months). Recurrence was associated with time to all-causes death (hazard ratio [HR] 4.3, p=0.003). Factors predictive of recurrence were perineural invasion (HR 5.3, p=0.02), lymph node invasion (HR 5.3, p=0.02) and differentiation (HR 0.2, p=0.05). Three patients underwent surgical R0 treatment of their recurrences. Two who presented with solitary liver metastasis are alive and disease-free.
  
  
  CONCLUSIONS
  Recurrence represents a serious threat in the prognosis of CAV after surgery. Some of these recurrences, in particular liver metastases, are accessible for a curative treatment. This finding supports the usefulness of a close and long-term follow-up after surgery to improve survival of patients with CAV, especially in the group of patients with a good prognosis.
authors.affiliation: Hepatobiliary Surgery and Transplantation, CHU Caen, Caen, France.
authors.forename: Laurence
authors.initials: L
authors.lastname: Chiche
authors.forename: Barbara
authors.initials: B
authors.lastname: Alkofer
authors.forename: Jean-Jacques
authors.initials: JJ
authors.lastname: Parienti
authors.forename: Vincent
authors.initials: V
authors.lastname: Rouleau
authors.forename: Ephrem
authors.initials: E
authors.lastname: Salamé
authors.forename: Guy
authors.initials: G
authors.lastname: Samama
authors.forename: Philippe
authors.initials: P
authors.lastname: Segol