The morbidity, mortality, and prognostic factors for ampullary carcinoma and distal cholangiocarcinoma.
OBJECTIVE
Ampullary carcinoma and distal cholangiocarcinoma are potentially more amenable to pancreaticoduodenectomy for long-term survival than pancreatic carcinoma. The aims of this study are to evaluate experience with ampullary carcinoma and distal cholangiocarcinoma at a single institution.


METHODS
Seventy-two consecutive patients with ampullary carcinoma and distal cholangiocarcinoma who underwent radical resection at Chiba University Hospital from 1985 to 2001. Clinicopathological factors for survival were evaluated by univariate and multivariate analyses in a retrospective study.


RESULTS
Pancreaticoduodenectomy was performed in 37 of 38 patients for ampullary carcinoma and 29 of 34 patients for distal cholangiocarcinoma. The morbidity rates of patients with ampullary carcinoma and distal cholangiocarcinoma were 21.1% and 20.6%, and mortality rates were 0% and 2.9%, respectively. The cumulative 5-year survival rates in cases of ampullary carcinoma and distal cholangiocarcinoma were 63% and 45%, respectively. By univariate analysis, pancreatic invasion, lymph node metastasis, and duodenal invasion were significant prognostic factors for ampullary carcinoma. Perineural invasion and histological grade, but not lymph node metastasis, were significant factors for distal cholangiocarcinoma. Multivariate analysis indicated that lymph node metastasis was the only independent prognostic factor for ampullary carcinoma, and that perineural invasion was the only independent prognostic factor for distal cholangiocarcinoma.


CONCLUSIONS
The overall mortality of 1.4% and the cumulative 5-year survival rates for ampullary carcinoma and distal cholangiocarcinoma are acceptable. Ampullary carcinoma with lymph node metastasis and distal cholangiocarcinoma with perineural invasion have higher risk of recurrence.
Shimizu
Yoshiaki
Y
Department of General Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba 260-0856, Japan, yoshiaki-shimizu@umin.ac.jp
Kimura
Fumihiko
F
Shimizu
Hiroaki
H
Yoshidome
Hiroyuki
H
Ohtsuka
Masayuki
M
Miyazaki
Masaru
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014670:Ampulla of Vater; D001650:Bile Duct Neoplasms / Q000401:mortality* / Q000601:surgery*; D001653:Bile Ducts, Intrahepatic; D018281:Cholangiocarcinoma / Q000401:mortality* / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate