This paper is only available as a PDF. To read, Please Download here.
Background. Results of pancreaticoduodenectomy for ampullary carcinoma were evaluated, and prognostic
factors for survival were analyzed.
Methods. During the period from 1984 to 1992 67 patients underwent subtotal or total pancreaticoduodenectomy
for ampullary carcinoma. All clinicopathologic data and their influence on survival
were studied.
Results. Subtotal pancreaticoduodenectomy was performed in 62 of 67 patients with a mortality
of 6% and a morbidity of 65%; the remaining five patients underwent total pancreaticoduodenectomy.
Intraabdominal infection was the most important complication. Resection margins were
tumor free in 75% of 67 patients. The overall 5-year survival was 50%. Survival was
significantly influenced by the involvement of resection margins. After resection
with involved margins 5-year survival was 15% and 60% after resection with free margins
(p<0.001). Tumor size, lymph node involvement, and differentiation grade had limited
and not significant influence on survival.
Conclusions. Subtotal pancreaticoduodenectomy is the type of resection of first choice for ampullary
carcinoma. Involvement of resection margins was the strongest prognostic factor for
survival. Patients with a tumor size larger than 2 cm, with lymph node involvement,
or with a poorly differentiated tumor still had a 5-year survival rate greater than
40%. Patients with involved margins might be, candidates for studies on adjuvant therapy.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Surgical treatment of cancer of the pancreas and the periampullary region.Ann Surg. 1977; 185: 52-57
- Carcinoma of the pancreas and periampullary region.Ann Surg. 1979; 189: 129-138
- Pancreaticoduodenal resection: surgical experience and evaluation of risk factors in 103 patients.Ann Surg. 1984; 199: 432-437
- Historical review of pancreaticoduodenectomy.Am J Surg. 1991; 161: 219-225
- Current status of pancreaticoduodenectomy for periampullary carcinoma.Hepatogastroenterology. 1989; 36: 478-485
- Results of radical resection for periampullary cancer.Ann Surg. 1975; 181: 534-540
- Periampullary tumors: which ones should be resected?.Am J Surg. 1985; 149: 46-52
- Experience with 647 consecutive tumors of the duodenum, ampulla, head of the pancreas and common bile duct.Ann Surg. 1989; 210: 544-556
- Improved hospital morbidity, mortality and survival after the Whipple procedure.Ann Surg. 1987; 206: 358-365
- Complications following pancreaticoduodenectomy: current management.Arch Surg. 1992; 127: 945-950
- Decreased morbidity and mortality after pancreaticoduodenectomy.Am J Surg. 1986; 151: 141-149
- Cancer of the pancreas, 50 years of surgery.Cancer. 1987; 60: 2284-2303
- Periampullary cancer. A clinicopathologic study of sixty-two patients.Am J Surg. 1976; 131: 141-148
- Radical pancreatoduodenectomy for cancer of the papilla of Vater.Arch Surg. 1977; 112: 451-456
- Carcinoma of the papilla of Vater. A review of fifty-seven cases.Am J Surg. 1978; 135: 763-770
- Twenty-two year experience with periampullary carcinoma at Memorial Sloan-Kettering Cancer Center.Am J Surg. 1979; 138: 662-665
- Pancreaticoduodenectomy. A 40-year experience.Ann Surg. 1982; 195: 608-617
- Surgical experience with pancreatic and periampullary cancer.Ann Surg. 1982; 195: 274-281
- Adenocarcinoma of the ampulla of Vater. Diagnosis and treatment.Ann Surg. 1982; 195: 152-157
- Pancreatic and periampullary carcinoma. Experience with 200 patients over a 12-year period.Am J Surg. 1982; 143: 189-193
- Carcinoma of the ampulla of Vater.Br J Surg. 1986; 73: 72-73
- Management of periampullary carcinoma.Br J Surg. 1987; 74: 816-819
- Pancreatic resection for carcinoma of the pancreas and the periampullary region in patients over 70 years of age.Br J Surg. 1987; 74: 116-118
- Carcinoma of the ampulla of Vater. A clinicopathologic study and pathologic staging of 109 cases of carcinoma and 5 cases of adenoma.Cancer. 1987; 59: 506-515
- Carcinoma of the ampulla of Vater.Ann Surg. 1987; 206: 572-577
- Long-term survival after resection of ampullary carcinoma is associated independently with tumor grade and a new staging classification that assesses local invasiveness.Cancer. 1988; 61: 1403-1407
- Pancreaticoduodenal resection for pancreatic or periampullary tumors—a ten-year experience.Hepatogastroenterology. 1989; 36: 467-473
- Significance of tumor spread in adenocarcinoma of the ampulla of Vater.Am J Surg. 1989; 158: 593-597
- Influence of site of origin and mucin production on survival in ampullary carcinoma.Ann Surg. 1989; 210: 173-179
- Long-term follow-up of 24 patients undergoing radical resection for ampullary carcinoma, 1953 to 1988.Cancer. 1990; 66: 1717-1720
- Radical resection for carcinoma of the ampulla of Vater.Arch Surg. 1991; 126: 353-357
- Patterns of failure after pancreaticoduodenectomy for ampullary carcinoma.Surg Gynecol Obstet. 1993; 176: 33-38
- The importance of tumour volume in the prognosis of radically treated periampullary carcinomas.Eur J Surg. 1993; 159: 95-100
- Eingeschränkte chirurgische Radikalität beim okkulten Karzinom der Papilla Vateri.Langenbecks Arch Chir. 1991; 376: 195-198
- Wide local excision as an alternative treatment for periampullary carcinoma.Am J Gastroenterol. 1987; 82: 1169-1171
Article info
Publication history
Accepted:
July 11,
1994
Identification
Copyright
© 1995 Mosby-Year Book, Inc. Published by Elsevier Inc.
