title: Long-term prognosis of surgical treatment for early ampullary cancers and implications for local ampullectomy.
abstract: BACKGROUND
  Early ampullary cancers present with good prognosis. Pancreaticoduodenectomy (PD) has been standard treatment for ampullary cancers, but it remains high rate of postoperative complications. So there raises a discussion on the role of local ampullectomy for early ampullary cancers (mainly focusing on pT1).
  
  
  METHODS
  89 patients with pT1 ampullary cancer who underwent surgical treatment between 1978 and 2010 were retrospectively studied.
  
  
  RESULTS
  Rate of postoperative complications, especially post-operative pancreatic fistula (P = 0.009), after PD was higher than after local ampullectomy, . Multivariate analysis showed that tumor size (HR 2.204; P = 0.014), lymph node metastasis (HR 4.362; P < 0.001), lymph vascular invasion (HR 4.258; P < 0.001), and perineural invasion (HR 4.467; P < 0.001), gross morphology (HR 2.536; P = 0.004) and tumor grade (HR 4.213; P = 0.001) were independent risk factors for long-term survival, as well as risk factors for failure of ampullectomy in early ampullary cancer. For patients absent of these factors, local ampullectomy would achieve a good prognosis.
  
  
  CONCLUSIONS
  Because of high rate of lymph node metastasis, PD should be preferably performed for radical resection. Local ampullectomy could be an alternative for patients in high operative risk; and would achieve a good outcome in patients whose tumors were well differentiated and showed polypoid gross morphology and size ≤1 cm.
authors.affiliation: Department of General Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China. songjunmin99@163.com.
authors.forename: Junmin
authors.initials: J
authors.lastname: Song
authors.affiliation: Department of General Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
authors.forename: Hongxiang
authors.initials: H
authors.lastname: Liu
authors.affiliation: Department of General Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
authors.forename: Zhen
authors.initials: Z
authors.lastname: Li
authors.affiliation: Department of General Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
authors.forename: Chao
authors.initials: C
authors.lastname: Yang
authors.affiliation: Department of General Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
authors.forename: Yuling
authors.initials: Y
authors.lastname: Sun
authors.affiliation: Department of Oncology, Henan Provincial People's Hospital, Zhengzhou, China.
authors.forename: Chaojie
authors.initials: C
authors.lastname: Wang
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014670:Ampulla of Vater / Q000601:surgery*; D003138:Common Bile Duct Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D016577:Pancreaticoduodenectomy; D011183:Postoperative Complications / Q000453:epidemiology; D011379:Prognosis; D012189:Retrospective Studies