title: Management and outcomes following pancreaticoduodenectomy for ampullary adenocarcinoma.
abstract: BACKGROUND
  The purpose of this study was to evaluate outcomes following pancreaticoduodenectomy(PD) for ampullary adenocarcinoma(AAC).
  
  
  METHODS
  We evaluated patients having undergone PD for AAC and the impact of clinical/histopathologic factors and adjuvant therapy(AT) on survival.
  
  
  RESULTS
  52 patients underwent potentially curative PD. Perineural and lymphovascular invasion were associated with decreased survival. There was no difference in survival between patients treated with PD vs. PD+AT, however, AT was more often administered to patients with N1 vs. N0 and stage II/III vs. I disease. Among patients receiving AT, we observed a trend towards improved survival when radiation was included. Recurrence occurred in 7/18(39%) stage I patients, only 2(7%) of which received AT.
  
  
  CONCLUSIONS
  AT did not improve survival, however was more commonly administered in advanced disease. Stage I patients had high recurrence rates but rarely received AT. Prospective evaluation of appropriate AT regimens and use in early stage patients should be considered.
authors.affiliation: Department of Surgery, Division of Surgical Oncology, University of Tennessee Health Science Center, Memphis, TN, USA.
authors.forename: M T
authors.initials: MT
authors.lastname: Chavez
authors.affiliation: Department of Surgery, Division of Surgical Oncology, University of Tennessee Health Science Center, Memphis, TN, USA.
authors.forename: J P
authors.initials: JP
authors.lastname: Sharpe
authors.affiliation: Memphis Pathology Group, Memphis, TN, USA.
authors.forename: T
authors.initials: T
authors.lastname: O'Brien
authors.affiliation: Pathology Group of the Midsouth, Germantown, TN, USA.
authors.forename: K T
authors.initials: KT
authors.lastname: Patton
authors.affiliation: Division of Hematology/Oncology, University of Tennessee Health Science Center and West Cancer Center, Memphis, TN, USA.
authors.forename: D C
authors.initials: DC
authors.lastname: Portnoy
authors.affiliation: Department of Radiation Oncology, University of Tennessee Health Science Center and West Cancer Center, Memphis, TN, USA.
authors.forename: N A
authors.initials: NA
authors.lastname: VanderWalde
authors.affiliation: Department of Surgery, Division of Surgical Oncology, University of Tennessee Health Science Center, Memphis, TN, USA.
authors.forename: J L
authors.initials: JL
authors.lastname: Deneve
authors.affiliation: Department of Surgery, Division of Surgical Oncology, University of Tennessee Health Science Center, Memphis, TN, USA.
authors.forename: D
authors.initials: D
authors.lastname: Shibata
authors.affiliation: Department of Surgery, Division of Surgical Oncology, University of Tennessee Health Science Center, Memphis, TN, USA.
authors.forename: S W
authors.initials: SW
authors.lastname: Behrman
authors.affiliation: Department of Surgery, Division of Surgical Oncology, University of Tennessee Health Science Center, Memphis, TN, USA. Electronic address: pdickso1@uthsc.edu.
authors.forename: P V
authors.initials: PV
authors.lastname: Dickson
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014670:Ampulla of Vater; D003138:Common Bile Duct Neoplasms / Q000401:mortality / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016577:Pancreaticoduodenectomy; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome
keywords: Adjuvant therapy; Ampullary adenocarcinoma; Pancreaticoduodenectomy; Prognosis