title: Prognostic Factors and Survival of Patients with Carcinoma of the Ampulla of Vater after Pancreaticoduodenectomy
abstract: Background: Although carcinoma of the ampulla of Vater (CAV) is a rare tumor, accounting for just 0.2% of
  gastrointestinal cancers, the survival of CAV patients is unfavorable. The five-year rates have ranged from 36.8-75.2% in
  previous reports but there is a lack of data relating to Thai people. Also prognostic factors are controversial. Objectives:
  This study aimed to determine survival outcomes and to identify prognostic factors for a positive outcome for CAV
  patients after surgery. Methods: In this retrospective cohort study, data were collected from CAV patients who underwent
  surgery in Chiang Mai University Hospital from 2005 to 2012 for time to event analysis, the log rank test and univariate
  and multivariate Cox’s regression analysis. Results: There were 72 CAV patients recruited, 45.8% being male. The mean
  age was 65.1 ± 10.5 years and the median waiting time for surgery was 56.5 days (24.5-91.5). The 30 day mortality
  rate was 5.6%., while 5-yr survival was 33.3%. The average disease free survival was 14.6 months. Prognostic factors
  relating to recurrence were positive lymph nodes (50% VS 19.6% p = 0.015) and advanced stage (44.1% VS 18.4%
  p = 0.023). Multivariate analysis showed that the potential prognostic factors for CAV patients included recurrence,
  moderate and poor differentiation, comorbidities and a tumor size > 2.0 cm. Conclusions: The findings of the study
  indicate that the overall survival of CAV patients after surgery is quite fair, with a tendency for better outcome with
  early as compared to advanced lesions. The key prognostic factors were recurrence, moderate and poor differentiation,
  comorbidity and tumor size > 2.0 cm.
authors.affiliation: Division of Hepatobiliarypancreas Surgery, Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai,
  Thailand. Email: sunhawit.j@cmu.ac.th
authors.forename: Sunhawit
authors.initials: S
authors.lastname: Junrungsee
authors.forename: Ekkapope
authors.initials: E
authors.lastname: Kittivarakul
authors.forename: Wasana
authors.initials: W
authors.lastname: Ko-iam
authors.forename: Worakitti
authors.initials: W
authors.lastname: Lapisatepun
authors.forename: Trichak
authors.initials: T
authors.lastname: Sandhu
authors.forename: Anon
authors.initials: A
authors.lastname: Chotirosniramit
keywords: Ampulla of Vater carcinoma; pancreaticoduodenectomy; survival