Prognostic factors for long-term survival in patients with ampullary carcinoma: the results of a 15-year observation period after pancreaticoduodenectomy.
Introduction. Although ampullary carcinoma has the best prognosis among all periampullary carcinomas, its long-term survival remains low. Prognostic factors are only available for a period of 10 years after pancreaticoduodenectomy. The aim of this retrospective study was to identify factors that influence the long-term patient survival over a 15-year observation period. Methods. From 1992 to 2007, 143 patients with ampullary carcinoma underwent pancreatic resection. 86 patients underwent pylorus-preserving pancreaticoduodenectomy (60%) and 57 patients underwent standard Kausch-Whipple pancreaticoduodenectomy (40%). Results. The overall 1-, 5-, 10-, and 15-year survival rates were 79%, 40%, 24%, and 10%, respectively. Within a mean observation period of 30 (0-205) months, 100 (69%) patients died. Survival analysis showed that positive lymph node involvement (P = 0.001), lymphatic vessel invasion (P = 0.0001), intraoperative administration of packed red blood cells (P = 0.03), an elevated CA 19-9 (P = 0.03), jaundice (P = 0.04), and an impaired patient condition (P = 0.01) are strong negative predictors for a reduced patient survival. Conclusions. Patients with ampullary carcinoma have distinctly better long-term survival than patients with pancreatic adenocarcinoma. Long-term survival depends strongly on lymphatic nodal and vessel involvement. Moreover, a preoperative elevated CA 19-9 proved to be a significant prognostic factor. Adjuvant therapy may be essential in patients with this risk constellation.
Department of General, Visceral, and Transplantation Surgery, Charité Campus Virchow Universitätsmedizin Berlin, 13353 Berlin, Germany.
Fritz
0000-0002-8940-6001
F
Klein
Department of General and Visceral Surgery, Bielefeld Evangelical Hospital, 33617 Bielefeld, Germany.
Dietmar
D
Jacob
Department of General, Visceral, and Transplantation Surgery, Charité Campus Virchow Universitätsmedizin Berlin, 13353 Berlin, Germany.
Marcus
M
Bahra
Department of Hematology/Oncology, Comprehensive Cancer Center, Charité Universitätsmedizin Berlin, 13353 Berlin, Germany.
Uwe
0000-0001-9213-2737
U
Pelzer
Department of General, Visceral, and Transplantation Surgery, Charité Campus Virchow Universitätsmedizin Berlin, 13353 Berlin, Germany.
Gero
G
Puhl
Department of Biostatistics, Coordination Center for Clinical Trials, Charité Universitätsmedizin Berlin, 13353 Berlin, Germany.
Alexander
A
Krannich
Department of General, Visceral, and Transplantation Surgery, Charité Campus Virchow Universitätsmedizin Berlin, 13353 Berlin, Germany.
Andreas
A
Andreou
Department of General, Visceral, and Transplantation Surgery, Charité Campus Virchow Universitätsmedizin Berlin, 13353 Berlin, Germany.
Safak
S
Gül
Department of General, Visceral, and Transplantation Surgery, Charité Campus Virchow Universitätsmedizin Berlin, 13353 Berlin, Germany.
Olaf
O
Guckelberger