title: The importance of choice of resection procedures in T1 and T2 stage of carcinoma of the ampulla of Vater.
abstract: OBJECTIVE
  The ampulla of Vater (AV), with its strategic location and its remarkable predisposition to the development of various malignant tumors, makes it very challenging for surgery. In this study we aimed to examine the prognostic factors in the treatment of early-stage carcinoma of the AV as well as to contribute to the choice of optimal surgical procedure.
  
  
  METHODS
  We analyzed 109 AV patients, hospitalized at the Clinical Center of Serbia from January 1999 to December 2008 and we compared the clinicopathological features, analyzed intra- and postoperative data, recurrences and survival, according to duodenopancreatectomy (DP) or local resection (LR).
  
  
  RESULTS
  DP was performed in 83 and LR in 26 patients. Overall survival (OS) was significantly influenced by the pathological (p) tumor stage (pT1/T2 vs pT3/T4), pathological nodal stage (pN0 vs pN1), perineural and vascular invasion, grade of tumor differentiation (G1 vs G3), and resection margin status (R0 vs R1). Kaplan-Meier analysis showed 64% 5-year overall survival of patients with pT1/T2 stage in the group with DP, and 58% in the group with LR (p>0.05). Survival analysis of pN1 patients in these two groups showed statistically significant difference (DP 49.67 vs LR 28.68 months, p<0.05). Postoperative complications occurred more frequently in patients treated with DP, compared with LR. Tumor recurrence occurred in 23.07% of LR patients and in 4.0% of DP patients, in pT1/T2 stage. The rate of in-hospital mortality was not significantly different in DP (9.78%) vs LR (0%) patients (p>0.05).
  
  
  CONCLUSIONS
  Resection is mandatory for all proven AV tumors, and DP is the treatment choice. LR, due to reduced morbidity and mortality, might be recommended in elderly patients with comorbidities and in patients with stage pT1/T2, pN0 and well differentiated (G1,G2) tumors.
authors.affiliation: Department of Hepatobiliary and Pancreatic Surgery, Clinic for Digestive Diseases, Clinical Center of Sebia, Belgrade, Serbia.
authors.forename: Slavenko M
authors.initials: SM
authors.lastname: Ostojic
authors.forename: Djordje R
authors.initials: DR
authors.lastname: Knezevic
authors.forename: Mirjana
authors.initials: M
authors.lastname: Perisic
authors.forename: Vladimir
authors.initials: V
authors.lastname: Jurisic
authors.forename: Srbislav M
authors.initials: SM
authors.lastname: Knezevic
mesh_terms: D000328:Adult; D014670:Ampulla of Vater; D003138:Common Bile Duct Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D016577:Pancreaticoduodenectomy / Q000009:adverse effects; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies