title: Comparative study of the radical and standard lymphadenectomy in the surgical treatment of adenocarcinoma of the ampula of Vater.
abstract: OBJECTIVE
  To evaluate the morbidity and mortality in patients undergoing surgical pancreatoduodenectomy (PD) in standard and radical lymphadenectomy for adenocarcinoma of papilla, analyzing the prognostic factors related to overall and disease-free survival.
  
  
  METHODS
  Were analyzed retrospectively from 1999 to 2007, in the Department of Abdominal and Pelvic Surgery (INCa-RJ), 50 cases of PD for adenocarcinoma of the duodenal papilla divided into two groups according to lymphadenectomy (group A: standard lymphadenectomy and group B: radical lymphadenectomy).
  
  
  RESULTS
  The median age was similar in both groups, as well as the distribution between the sex. In the comparison between the lymphadenectomies, only the number of lymph nodes resected (group A: 12.3 and group B: 26.5) and operative time (group A: 421 and group B: 474) were significantly different. There were no statistically significant differences in the two groups with respect to morbidity and mortality rate and length of hospitalization. The disease-free survival (group A: 35 months and group B: 51 months) and overall survival (group A: 38 months and group B: 53 months) was higher in the group of radical lymphadenectomy, but were not statistically significant.
  
  
  CONCLUSIONS
  In this study there were no cases of metastatic lymph nodes to other groups without nodal involvement of the pancreatic-duodenal lymph node chains (13, 17), suggesting a pattern of lymph node spread. Despite the radical lymphadenectomy present rates of disease-free survival and overall survival largest such data were not statistically significant. Further studies should be conducted to evaluate the real role of radical lymphadenectomy in adenocarcinoma of the duodenal papilla.
authors.affiliation: Abdomino-Pelvic Surgery Service, Instituto Nacional de Câncer, Rio de Janeiro, RJ, Brazil. rafaelalbagli@uol.com.br
authors.forename: Rafael Oliveira
authors.initials: RO
authors.lastname: Albagli
authors.forename: Gustavo Santos Stoduto de
authors.initials: GS
authors.lastname: Carvalho
authors.forename: Jorge
authors.initials: J
authors.lastname: Mali Junior
authors.forename: José Marcos Raso
authors.initials: JM
authors.lastname: Eulálio
authors.forename: Eduardo Linhares Rielo
authors.initials: EL
authors.lastname: de Melo
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery*; D014670:Ampulla of Vater; D003138:Common Bile Duct Neoplasms / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies