Predictors of long-term survival following resection for ampullary carcinoma: a large retrospective French multicentric study.
OBJECTIVE
Ampullary carcinoma is a rare tumor. There are neither sufficient available data related to management after resection of the neoplasm of the ampulla of Vater, nor any international recommendations. The aim of this study was to identify factors associated with recurrence and survival after curative resection.


METHODS
A retrospective follow-up study was conducted including patients with ampullary carcinoma who underwent resection with curative intent in 12 French surgical centers between January 1990 and November 2011.


RESULTS
In this study, 319 patients underwent surgical resection for an ampullary neoplasm. Disease recurred in 120 patients (37.6%), and the 5- and 10-year disease-free survival rates were 48.9% and 40.4%, respectively. In multivariable Cox regression, preoperative bilirubin, T stage, pancreaticobiliary histology subtype, and lymph node involvement were each significantly associated with the risk of recurrence.


CONCLUSIONS
Ampullary carcinomas are a heterogeneous group that can be classified as intestinal and pancreaticobiliary subtypes. Our findings indicate that pancreaticobiliary differentiation, advanced stage, and lymph node involvement are predictors of both poor disease-free and poor overall survival. It is still unclear what adjuvant treatment after curative resection of ampullary carcinoma is optimal. It would be informative to evaluate adjuvant therapy according to histological subtype.
From the *Department of Digestive Surgery and Hepatic Transplantation, University Hospital Center of Tours, Tours; †Department of Epidemiology and Biostatistics, University Hospital Center of Nantes, Nantes; ‡Department of Digestive Surgery, La Timone AP-HM, Marseille; §Department of Hepato Biliary and Digestive Surgery, University Hospital Center of Bordeaux, Bordeaux; ∥Department of General and Digestive Surgery, Hopital Saint-Antoine AP-HP, Paris; ¶Department of Hepato Biliary and Digestive Surgery, University Hospital Center of Rennes, Rennes; #Department of Oncology Surgery, Institut Paoli Calmettes, Marseille; **Department of General and Digestive Surgery, University Hospital Center of Rouen, Rouen; ††Department of General and Digestive Surgery, Purpan, and ‡‡Department of General and Digestive Surgery, Rangueil, University Hospital Center of Toulouse, Toulouse; §§Department of Digestive Pathology, Institut Mutualiste Montsouris, Paris; ∥∥Department of Digestive Surgery, University Hospital Center of Angers, Angers; and ¶¶Digestive and Endocrine Surgery Clinic, IMAD, University Hospital Center of Nantes, Nantes, France.
Pierre-Emmanuel
PE
Robert
Christophe
C
Leux
Mehdi
M
Ouaissi
Mathieu
M
Miguet
François
F
Paye
Aude
A
Merdrignac
Jean Robert
JR
Delpero
Lilian
L
Schwarz
Nicolas
N
Carrere
Fabrice
F
Muscari
Brice
B
Gayet
David
D
Dussart
Antoine
A
Hamy
Nicolas
N
Regenet
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014670:Ampulla of Vater; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D003138:Common Bile Duct Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D005602:France; D006801:Humans; D053208:Kaplan-Meier Estimate; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data; D010190:Pancreatic Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D013997:Time Factors