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Patterns and Predictors of Failure after Curative Resections of Carcinoma of the Ampulla of Vater

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Abstract

Background:Curative resection does not always equate with long-term survival. The aim was to identify patterns and predictors of failure and independent factors of prognosis after curative resection.

Methods:Sixty-six patients with ampullary carcinoma who underwent surgical intervention were reviewed. Fifty-nine patients underwent pancreaticoduodenectomy. Cox regression analysis, log-rank test, Fisher exact test, or χ2 test was used.

Results:No patient died as a result of surgery; major complications occurred in three, and the 5-year survival rate after curative resection (n = 55) was 52.6%. Significant survival predictors were preoperative serum carcinoembryonic antigen level; gross tumor appearance; tumor, node, and tumor node metastasis stage; and microscopic lymphatic vessel and venous invasion in the primary tumor. Multivariate analysis demonstrated that lymphatic vessel invasion, tumor, and tumor node metastasis stage were significant independent prognostic factors. No patient experienced locoregional failure alone; all 24 relapsed patients had distant failure, and six of them had both. The liver was the most frequent metastatic organ, followed by nodes, peritoneum, lung, and bone. The carcinoembryonic antigen and carbohydrate antigen levels and lymphatic vessel and venous invasion were significant predictors of distant failure, and the mean time to relapse was 13 (range, 0.7–33) months.

Conclusions:Curative resection is associated with significant survival; however, effective systemic adjuvant therapy is needed to prevent distant failure for patients with elevated carcinoembryonic antigen and carbohydrate antigen levels or positive lymphatic vessel or venous invasion. A 3-year follow-up period would be necessary to document relapses.

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Authors and Affiliations

  1. Department of Surgery, Hitachi Mito General Hospital, Hitachi, Japan

    Takeshi Todoroki MD, PhD (Associate Professor), Naoto Koike MD, PhD, Toru Kawamoto MD, PhD & Nobuhiro Ohkohchi MD, PhD

  2. Department of Pathology, Hitachi Mito General Hospital, Hitachi, Japan

    Yukio Morishita MD, PhD

  3. Department of Internal Medicine, Hitachi Mito General Hospital, Hitachi, Japan

    Junichi Shoda MD, PhD

  4. Institute of Clinical Medicine and Department of Epidemiology and Biostatistics, Hitachi Mito General Hospital, Hitachi, Japan

    Hideto Takahashi PhD

  5. Institute of Community of Medicine, University of Tsukuba, Tsukuba-Shi

    Yoshiharu Fukuda MD

  6. Department of Surgery, Institute of Clinical Medicine, University of Tsukuba, Tsukuba-Shi, 305-8575, Japan

    Takeshi Todoroki MD, PhD (Associate Professor)

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  1. Takeshi Todoroki MD, PhD
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  2. Naoto Koike MD, PhD
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  3. Yukio Morishita MD, PhD
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  4. Toru Kawamoto MD, PhD
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  5. Nobuhiro Ohkohchi MD, PhD
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  6. Junichi Shoda MD, PhD
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  7. Yoshiharu Fukuda MD
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  8. Hideto Takahashi PhD
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Correspondence to Takeshi Todoroki MD, PhD.

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Todoroki, T., Koike, N., Morishita, Y. et al. Patterns and Predictors of Failure after Curative Resections of Carcinoma of the Ampulla of Vater. Ann Surg Oncol 10, 1176–1183 (2003). https://doi.org/10.1245/ASO.2003.07.512

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  • DOI: https://doi.org/10.1245/ASO.2003.07.512

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