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Annals of Surgical Oncology

, Volume 14, Issue 1, pp 50–60 | Cite as

Predictors for Patterns of Failure after Pancreaticoduodenectomy in Ampullary Cancer

  • Hui-Ping Hsu
  • Ta-Ming Yang
  • Yu-Hsiang Hsieh
  • Yan-Shen ShanEmail author
  • Pin-Wen Lin
Article

Abstract

Background

Ampullary cancer has the best prognosis in periampullary malignancy but unpredicted early recurrence after resection is frequent. The current study tried to find the predictors for recurrence to be used as determinative for postoperative adjuvant therapy.

Methods

Information was collected from patients who underwent pancreaticoduodenectomy with regional lymphadenectomy for ampullary cancer in high-volume hospitals between January 1989 and April 2005. Recurrence patterns and survival rates were calculated and predictors were identified.

Results

A total of 135 eligible patients were included. The 30-day operative mortality was 3%. Median followup for relapse-free patients was 52 months. Disease recurred in 57 (42%) patients, including 31 liver metastases, 26 locoregional recurrences, 9 peritoneal carcinomatoses, 7 bone metastases, and 6 other sites. Pancreatic invasion (P = 0.04) and tumor size (P = 0.05) were the predictors for locoregional recurrence, while lymph node metastasis was the sole predictor for liver metastasis (P = 0.01). The 5-year disease-specific survival rate was 45.7%; 77.7% for stage I, 28.5% for stage II, and 16.5% for stage III; and 63.7% for node-negative versus 19.1% for node-positive patients. Pancreatic invasion and lymph node involvement were both predictors for survival of patients with ampullary cancer.

Conclusion

Pancreaticoduodenectomy with regional lymphadenectomy is adequate for early-stage ampullary cancer but a dismal outcome can be predicted in patients with lymph node metastasis and pancreatic invasion. Lymph node metastasis and pancreatic invasion can be used to guide individualized, risk-oriented adjuvant therapy.

Keywords

Ampulla of Vater Pancreaticoduodenectomy 

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Copyright information

© Society of Surgical Oncology 2006

Authors and Affiliations

  • Hui-Ping Hsu
    • 1
  • Ta-Ming Yang
    • 2
  • Yu-Hsiang Hsieh
    • 3
  • Yan-Shen Shan
    • 1
    Email author
  • Pin-Wen Lin
    • 1
  1. 1.Department of Surgery, National Cheng Kung University Hospital, College of MedicineNational Cheng Kung UniversityTainanTaiwan (ROC)
  2. 2.Department of SurgeryTainan Municipal HospitalTainanTaiwan
  3. 3.Department of Emergency MedicineThe Johns Hopkins University School of MedicineBaltimoreUSA

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