• We are sorry, but NCBI web applications do not support your browser and may not function properly. More information
Logo of annsurgLink to Publisher's site
Ann Surg. Jul 1998; 228(1): 87–94.
PMCID: PMC1191432

Factors predictive of survival in ampullary carcinoma.

Abstract

OBJECTIVE: To review the recent Memorial Sloan-Kettering Cancer Center experience with adenocarcinoma of the ampulla of Vater and to identify clinicopathologic factors that have an impact on patient survival. SUMMARY BACKGROUND DATA: The prognosis for patients with tumors of the ampulla of Vater is improved relative to other periampullary neoplasms. Identification of independent prognostic factors in ampullary tumors has been limited by small numbers of tumors and a lack of pathologic review. METHODS: Data were collected prospectively for patients presenting with periampullary carcinomas to the Memorial Sloan-Kettering Cancer Center between October 15, 1983 and June 30, 1995. The correlation between clinicopathologic variables and survival of ampullary carcinoma was tested by the Kaplan-Meier method and log-rank test, and Cox proportional hazards regression. Survival of patients with periampullary adenocarcinomas was compared by the Kaplan-Meier method. RESULTS: In 123 patients presenting with ampullary carcinoma, 101 tumors (82.1%) were resected. Factors significantly correlated with improved survival were resection (p < 0.01), and in resected tumors, negative nodes (p = 0.04) and margins (p = 0.02) independently predicted for improved survival. In periampullary tumors, the highest rates of resection and overall survival (median, 43.6 months) were found in ampullary carcinomas. CONCLUSIONS: Factors predictive of improved survival in ampullary carcinoma include resection, negative margins, and negative nodes. Improved overall survival in ampullary relative to periampullary adenocarcinoma is due in part to a significantly higher rate of resection.

Full text

Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (1.7M), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References.

Images in this article

Click on the image to see a larger version.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Whipple AO, Parsons WB, Mullins CR. TREATMENT OF CARCINOMA OF THE AMPULLA OF VATER. Ann Surg. 1935 Oct;102(4):763–779. [PMC free article] [PubMed]
  • WHIPPLE AO. A reminiscence: pancreaticduodenectomy. Rev Surg. 1963 Jul-Aug;20:221–225. [PubMed]
  • Neoptolemos JP, Talbot IC, Carr-Locke DL, Shaw DE, Cockleburgh R, Hall AW, Fossard DP. Treatment and outcome in 52 consecutive cases of ampullary carcinoma. Br J Surg. 1987 Oct;74(10):957–961. [PubMed]
  • Warren KW, Choe DS, Plaza J, Relihan M. Results of radical resection for periampullary cancer. Ann Surg. 1975 May;181(5):534–540. [PMC free article] [PubMed]
  • Cohen JR, Kuchta N, Geller N, Shires GT, Dineen P. Pancreaticoduodenectomy. A 40-year experience. Ann Surg. 1982 May;195(5):608–617. [PMC free article] [PubMed]
  • Lerut JP, Gianello PR, Otte JB, Kestens PJ. Pancreaticoduodenal resection. Surgical experience and evaluation of risk factors in 103 patients. Ann Surg. 1984 Apr;199(4):432–437. [PMC free article] [PubMed]
  • Jones BA, Langer B, Taylor BR, Girotti M. Periampullary tumors: which ones should be resected? Am J Surg. 1985 Jan;149(1):46–52. [PubMed]
  • Tarazi RY, Hermann RE, Vogt DP, Hoerr SO, Esselstyn CB, Jr, Cooperman AM, Steiger E, Grundfest S. Results of surgical treatment of periampullary tumors: a thirty-five-year experience. Surgery. 1986 Oct;100(4):716–723. [PubMed]
  • Crist DW, Sitzmann JV, Cameron JL. Improved hospital morbidity, mortality, and survival after the Whipple procedure. Ann Surg. 1987 Sep;206(3):358–365. [PMC free article] [PubMed]
  • Michelassi F, Erroi F, Dawson PJ, Pietrabissa A, Noda S, Handcock M, Block GE. Experience with 647 consecutive tumors of the duodenum, ampulla, head of the pancreas, and distal common bile duct. Ann Surg. 1989 Oct;210(4):544–556. [PMC free article] [PubMed]
  • Trede M, Schwall G, Saeger HD. Survival after pancreatoduodenectomy. 118 consecutive resections without an operative mortality. Ann Surg. 1990 Apr;211(4):447–458. [PMC free article] [PubMed]
  • Chan C, Herrera MF, de la Garza L, Quintanilla-Martinez L, Vargas-Vorackova F, Richaud-Patín Y, Llorente L, Uscanga L, Robles-Diaz G, Leon E, et al. Clinical behavior and prognostic factors of periampullary adenocarcinoma. Ann Surg. 1995 Nov;222(5):632–637. [PMC free article] [PubMed]
  • Monson JR, Donohue JH, McEntee GP, McIlrath DC, van Heerden JA, Shorter RG, Nagorney DM, Ilstrup DM. Radical resection for carcinoma of the ampulla of Vater. Arch Surg. 1991 Mar;126(3):353–357. [PubMed]
  • Talamini MA, Moesinger RC, Pitt HA, Sohn TA, Hruban RH, Lillemoe KD, Yeo CJ, Cameron JL. Adenocarcinoma of the ampulla of Vater. A 28-year experience. Ann Surg. 1997 May;225(5):590–600. [PMC free article] [PubMed]
  • Robertson JF, Imrie CW, Hole DJ, Carter DC, Blumgart LH. Management of periampullary carcinoma. Br J Surg. 1987 Sep;74(9):816–819. [PubMed]
  • Allema JH, Reinders ME, van Gulik TM, van Leeuwen DJ, Verbeek PC, de Wit LT, Gouma DJ. Results of pancreaticoduodenectomy for ampullary carcinoma and analysis of prognostic factors for survival. Surgery. 1995 Mar;117(3):247–253. [PubMed]
  • Roder JD, Schneider PM, Stein HJ, Siewert JR. Number of lymph node metastases is significantly associated with survival in patients with radically resected carcinoma of the ampulla of Vater. Br J Surg. 1995 Dec;82(12):1693–1696. [PubMed]
  • Nakase A, Matsumoto Y, Uchida K, Honjo I. Surgical treatment of cancer of the pancreas and the periampullary region: cumulative results in 57 institutions in Japan. Ann Surg. 1977 Jan;185(1):52–57. [PMC free article] [PubMed]
  • Hayes DH, Bolton JS, Willis GW, Bowen JC. Carcinoma of the ampulla of Vater. Ann Surg. 1987 Nov;206(5):572–577. [PMC free article] [PubMed]
  • Schlippert W, Lucke D, Anuras S, Christensen J. Carcinoma of the papilla of Vater. A review of fifty-seven cases. Am J Surg. 1978 Jun;135(6):763–770. [PubMed]
  • Walsh DB, Eckhauser FE, Cronenwett JL, Turcotte JG, Lindenauer SM. Adenocarcinoma of the ampulla of Vater. Diagnosis and treatment. Ann Surg. 1982 Feb;195(2):152–157. [PMC free article] [PubMed]
  • Martin FM, Rossi RL, Dorrucci V, Silverman ML, Braasch JW. Clinical and pathologic correlations in patients with periampullary tumors. Arch Surg. 1990 Jun;125(6):723–726. [PubMed]
  • Kellum JM, Clark J, Miller HH. Pancreatoduodenectomy for resectable malignant periampullary tumors. Surg Gynecol Obstet. 1983 Oct;157(4):362–366. [PubMed]
  • Delcore R, Jr, Connor CS, Thomas JH, Friesen SR, Hermreck AS. Significance of tumor spread in adenocarcinoma of the ampulla of Vater. Am J Surg. 1989 Dec;158(6):593–597. [PubMed]
  • Mori K, Ikei S, Yamane T, Yamaguchi Y, Katsumori T, Shibata Y, Arai T. Pathological factors influencing survival of carcinoma of the ampulla of Vater. Eur J Surg Oncol. 1990 Jun;16(3):183–188. [PubMed]
  • Tsao JI, Rossi RL, Lowell JA. Pylorus-preserving pancreatoduodenectomy. Is it an adequate cancer operation. Arch Surg. 1994 Apr;129(4):405–412. [PubMed]
  • Yamaguchi K, Nagai E, Ueki T, Nishihara K, Tamaka M. Carcinoma of the ampulla of Vater. Aust N Z J Surg. 1993 Apr;63(4):256–262. [PubMed]
  • Connolly MM, Dawson PJ, Michelassi F, Moossa AR, Lowenstein F. Survival in 1001 patients with carcinoma of the pancreas. Ann Surg. 1987 Sep;206(3):366–373. [PMC free article] [PubMed]
  • Nitecki SS, Sarr MG, Colby TV, van Heerden JA. Long-term survival after resection for ductal adenocarcinoma of the pancreas. Is it really improving? Ann Surg. 1995 Jan;221(1):59–66. [PMC free article] [PubMed]
  • Matory YL, Gaynor J, Brennan M. Carcinoma of the ampulla of Vater. Surg Gynecol Obstet. 1993 Oct;177(4):366–370. [PubMed]
  • Branum GD, Pappas TN, Meyers WC. The management of tumors of the ampulla of Vater by local resection. Ann Surg. 1996 Nov;224(5):621–627. [PMC free article] [PubMed]
  • Knox RA, Kingston RD. Carcinoma of the ampulla of Vater. Br J Surg. 1986 Jan;73(1):72–73. [PubMed]
  • Rose DM, Hochwald SN, Klimstra DS, Brennan MF. Primary duodenal adenocarcinoma: a ten-year experience with 79 patients. J Am Coll Surg. 1996 Aug;183(2):89–96. [PubMed]
  • Conlon KC, Klimstra DS, Brennan MF. Long-term survival after curative resection for pancreatic ductal adenocarcinoma. Clinicopathologic analysis of 5-year survivors. Ann Surg. 1996 Mar;223(3):273–279. [PMC free article] [PubMed]
  • Howe JR, Klimstra DS, Cordon-Cardo C, Paty PB, Park PY, Brennan MF. K-ras mutation in adenomas and carcinomas of the ampulla of vater. Clin Cancer Res. 1997 Jan;3(1):129–133. [PubMed]
  • Herter FP, Cooperman AM, Ahlborn TN, Antinori C. Surgical experience with pancreatic and periampullary cancer. Ann Surg. 1982 Mar;195(3):274–281. [PMC free article] [PubMed]
  • Chareton B, Coiffic J, Landen S, Bardaxoglou E, Campion JP, Launois B. Diagnosis and therapy for ampullary tumors: 63 cases. World J Surg. 1996 Jul-Aug;20(6):707–712. [PubMed]

Articles from Annals of Surgery are provided here courtesy of Lippincott, Williams, and Wilkins

Formats:

Related citations in PubMed

See reviews...See all...

Cited by other articles in PMC

See all...

Links

  • Cited in Books
    Cited in Books
    PubMed Central articles cited in books
  • MedGen
    MedGen
    Related information in MedGen
  • PubMed
    PubMed
    PubMed citations for these articles

Recent Activity

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

See more...