Predictors of clinical outcomes of resected ampullary adenocarcinoma: A single-institution experience

• Published in: European journal of surgical oncology Vol. 37; no. 9; pp. 791 - 797
• Main Authors: Lazaryan, A, Kalmadi, S, Almhanna, K, Pelley, R, Kim, R
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.09.2011
• Subjects: Adenocarcinoma; Adenocarcinoma - mortality; Adenocarcinoma - pathology; Adenocarcinoma - secondary; Adenocarcinoma - surgery; Adult; Aged; Aged, 80 and over; Ampulla of Vater; Clinical outcomes; Common Bile Duct Neoplasms - mortality; Common Bile Duct Neoplasms - pathology; Common Bile Duct Neoplasms - surgery; Female; Hematology, Oncology and Palliative Medicine; Humans; Lymphatic Metastasis; Male; Middle Aged; Pancreaticoduodenectomy; Risk factors; Surgery; Survival Analysis; Survival Rate; Adenocarcinoma; Ampulla of Vater; Risk factors; Clinical outcomes
• ISSN: 0748-7983; 1532-2157
• DOI: 10.1016/j.ejso.2011.06.008

Abstract Background In the absence of prospective data, the use of adjuvant therapy in ampullary adenocarcinoma is contingent upon the clinicopathological features which can correlate to 5-year post-operative survival and disease relapse. Methods We investigated the factors associated with clinical outcomes among 72 patients who underwent pancreatoduodenectomy at the Cleveland Clinic from 1995 to 2007 for histologically confirmed adenocarcinoma of the ampulla of Vater. Results R0 resection was achieved in 96% of patients (median age, 72 years; 58% males, 89% Caucasians). Nineteen patients experienced disease relapse after surgery and 61% were alive within 5 years of follow up. Thirty five percent of patients received some form of adjuvant therapy. Perineural tumor invasion ( p  < 0.01) and presence of ulcerated tumor on histopathology ( p  < 0.01) were associated with higher rates of tumor relapse and poor 5-year overall survival in multivariable analysis. Lymph node involvement ( p  = 0.02) also portended poor overall survival after adjustment for other covariates. Although adjuvant therapy was associated with poor clinical outcomes in univariate analysis, it demonstrated a favorable albeit non-significant trend in multivariable analysis. Conclusions Factors associated with poor clinical outcomes in this contemporary single-institution study, included perineural invasion, tumor ulceration, and lymph node involvement. No definite conclusion could be made in regards to adjuvant treatment.