title: Safety and efficacy of curative intent surgery for peri-ampullary liver metastasis.
abstract: BACKGROUND
  The management of patients with peri-ampullary liver metastasis remains controversial. We sought to assess the safety and efficacy of curative intent surgery for peri-ampullary liver metastasis.
  
  
  METHODS
  Between 1993 and 2009, 40 patients underwent curative intent surgery (resection and/or radiofrequency ablation (RFA)) for peri-ampullary liver metastasis. Clinicopathologic and outcome data were collected and analyzed.
  
  
  RESULTS
  Location of the primary tumor was pancreas head (n = 20), ampulla of Vater (n = 10), distal bile duct (n = 5), or duodenum (n = 5). Most patients (n = 27) presented with synchronous disease, while 13 patients presented with metachronous disease following a median disease-free interval of 22 months. Most patients (n = 25) presented with hepatic metastasis from pancreaticobiliary origin (pancreatic or distal common bile duct) compared with 15 patients who had metastasis from an intestinal-type primary (ampullary or duodenal). There were no differences in metastatic tumor number or size between these groups (P > 0.05). Post-operative morbidity and mortality was 30% and 5% respectively. Overall 1- and 3-year survival was 55% and 18%. Patients who underwent resection of liver metastasis from intestinal-type tumors experienced a longer survival compared with patients who had pancreaticobiliary lesions (median: 13 months vs. 23 months; P = 0.05).
  
  
  CONCLUSIONS
  Curative intent surgery for peri-ampullary liver metastasis was associated with post-operative morbidity and a 5% mortality rate. Although the overall survival benefit was modest, patients with liver metastasis from intestinal-type tumors experienced improved survival following resection of liver metastasis compared with pancreaticobiliary lesions.
authors.affiliation: Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
authors.forename: Mechteld C
authors.initials: MC
authors.lastname: de Jong
authors.forename: Susan
authors.initials: S
authors.lastname: Tsai
authors.forename: John L
authors.initials: JL
authors.lastname: Cameron
authors.forename: Christopher L
authors.initials: CL
authors.lastname: Wolfgang
authors.forename: Kenzo
authors.initials: K
authors.lastname: Hirose
authors.forename: Mark G
authors.initials: MG
authors.lastname: van Vledder
authors.forename: Frederic
authors.initials: F
authors.lastname: Eckhauser
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Herman
authors.forename: Barish H
authors.initials: BH
authors.lastname: Edil
authors.forename: Michael A
authors.initials: MA
authors.lastname: Choti
authors.forename: Richard D
authors.initials: RD
authors.lastname: Schulick
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Pawlik
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014670:Ampulla of Vater / Q000473:pathology*; D017115:Catheter Ablation / Q000009:adverse effects; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology