title: Adenocarcinoma of the ampulla of Vater: predictors of survival and recurrence after curative radical resection.
abstract: OBJECTIVE
  Because of low incidence rates, there have been few reports on the patterns of and risk factors for recurrence after curative resection of the ampulla of Vater (AoV) cancer. The aim of this study was to characterize patterns of recurrence and to evaluate risk factors affecting survival rates and recurrence after curative resection.
  
  
  METHODS
  Medical records of 181 patients who had undergone pancreaticoduodenectomy with curative intent for AoV adenocarcinoma between December 1994 and March 2010 at Samsung Medical Center were retrospectively reviewed. Factors influencing on overall survival rate, recurrence rates, and recurrence patterns were analyzed.
  
  
  RESULTS
  Lymph node metastases and high preoperative serum carcinoembryonic antigen (CEA) level >5 ng/ml were identified as independent factors affecting overall survival (p=0.006, p<0.001, respectively). Among the 181 patients, 69 developed local or distant recurrence within 3 years after curative resection. Lymph node metastasis, preoperative serum CEA level >5 ng/ml, and total bilirubin level >1.5 mg/dl were identified as independent prognostic factors of recurrence after curative resection (p=0.008, p<0.001, p=0.003, respectively).
  
  
  CONCLUSIONS
  AoV adenocarcinoma has a better prognosis than other periampullary carcinomas, but still has a high recurrence rate, especially during the first three years after curative radical resection. Therefore, careful follow-up is needed during the first 3 years, especially for the higher risk group. Further study of adjuvant therapy to decrease recurrence after curative resection is now warranted.
authors.affiliation: Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Kang Jae
authors.initials: KJ
authors.lastname: Kim
authors.affiliation: Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Dong Wook
authors.initials: DW
authors.lastname: Choi
authors.affiliation: Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Woo Seok
authors.initials: WS
authors.lastname: Kim
authors.affiliation: Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Min Jung
authors.initials: MJ
authors.lastname: Kim
authors.affiliation: Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Sun Choon
authors.initials: SC
authors.lastname: Song
authors.affiliation: Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Jin Seok
authors.initials: JS
authors.lastname: Heo
authors.affiliation: Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Seong Ho
authors.initials: SH
authors.lastname: Choi
keywords: Adenocarcinoma; Ampulla of Vater; Pancreaticoduodenectomy; Prognosis; Recurrence