Annals of Surgical Oncology

, Volume 15, Issue 11, pp 3178–3186

Prognostic Relevance of Lymph Node Ratio and Number of Resected Nodes after Curative Resection of Ampulla of Vater Carcinoma

  • Massimo Falconi
  • Stefano Crippa
  • Ismael Domínguez
  • Giuliano Barugola
  • Paola Capelli
  • Stefano Marcucci
  • Stefania Beghelli
  • Aldo Scarpa
  • Claudio Bassi
  • Paolo Pederzoli
Hepatic and Pancreatic Tumors

DOI: 10.1245/s10434-008-0099-4

Cite this article as:
Falconi, M., Crippa, S., Domínguez, I. et al. Ann Surg Oncol (2008) 15: 3178. doi:10.1245/s10434-008-0099-4

Abstract

Background

Nodal metastasis is considered a major prognostic factor in patients with ampulla of Vater carcinoma (AVC). No study has investigated the significance of the ratio between metastatic and resected/examined lymph nodes (LNR) in patients with AVC.

Methods

Demographic, operative, and pathology data, including number of resected/evaluated nodes and LNR, were collected from patients who underwent pancreaticoduodenectomy with radical intent for invasive AVC from 1990 to 2005. Survival rates and recurrence patterns were evaluated and predictors were identified.

Results

In 90 evaluable patients (51 males, 39 females, median age 62.5 years), 5-year disease-specific survival (DSS) was 61%. The median number of resected/evaluated nodes was 16 (range: 5–47); 50% of the patients had nodal metastases. The 5-year DSS according to LNR was 75%, 49%, 38%, and 0% for LNR = 0, LNR >0 and ≤0.2, LNR >0.2, and ≤0.4, and LNR >0.4 (P = 0.002), respectively. The 5-year DSS was 81% in patients with >16 resected/evaluated nodes compared with 45% in those with ≤16 resected/evaluated nodes (P = 0.001). On multivariate analysis LNR and a number of resected/evaluated nodes >16 were significant predictors of survival; a number of resected/evaluated nodes >16 was also the only independent predictor of recurrence.

Conclusions

After curative resection for AVC, LNR and a cutoff of 16 resected/evaluated nodes are powerful prognostic factors. LNR might represent a major parameter for patient stratification in adjuvant treatment trials.

Keywords

Ampullary cancer Lymph node ratio Prognosis Lymphadenectomy Staging Surgery 

Copyright information

© Society of Surgical Oncology 2008

Authors and Affiliations

  • Massimo Falconi
    • 1
  • Stefano Crippa
    • 1
  • Ismael Domínguez
    • 2
  • Giuliano Barugola
    • 1
  • Paola Capelli
    • 3
  • Stefano Marcucci
    • 1
  • Stefania Beghelli
    • 4
  • Aldo Scarpa
    • 3
  • Claudio Bassi
    • 1
  • Paolo Pederzoli
    • 1
  1. 1.Chirurgia Generale B (Pancreas Unit), Department of SurgeryUniversity of VeronaVeronaItaly
  2. 2.Department of Surgery (ID)Instituto Nacional de Ciencias Medicas y Nutricion “Salvador Zubiran”Mexico CityMexico
  3. 3.Department of PathologyUniversity of VeronaVeronaItaly
  4. 4.IRCCS Istituto Oncologico VenetoPadovaItaly