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Adequacy of Lymph Node Retrieval for Ampullary Cancer and Its Association with Improved Staging and Survival

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Abstract

Background

The aim of the present study was to determine the optimal number of lymph nodes (LN) examined to stage pN0 tumors after surgery for ampulla of Vater carcinoma (AVC).

Methods

We reviewed retrospectively 127 patients with AVC who underwent pancreaticoduodenectomy (1990–2008). Univariate and multivariate analysis was performed.

Results

Fifty-nine patients (46.5 %) were pN0, whereas 68 patients (53.5 %) were pN1. The 5-year disease-specific survival (DSS) was worse for pN1 patients than for pN0 patients (46 vs. 77 %; P < 0.0001). In the pN0 cohort, the optimal cut-off number of LN analyzed was found to be 12. The 5-year DSS for patients with ≤12 LN was 50 %, compared with 89 % in those with >12 LN (P = 0.001). By multivariate analysis, a LN count >12 was the only independent predictor associated with improved survival (HR 0.16, P = 0.003) among pN0 patients. Among pN1 patients, a LN count >12 was associated with a significantly better 5-year DSS (59 vs. 22 %; P = 0.027). Patients with a lymph node ratio (LNR) >0.20 had a 5-year DSS of 24 %, compared with 58 % in those with 0 < LNR ≤ 0.20 (P = 0.038).

Conclusions

Removal of more than 12 LN for examination is associated with improved survival rate after surgery for AVC in both pN0 and pN1 patients.

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Acknowledgments

This work was supported by Associazione Italiana Ricerca Cancro (AIRC), Milan, Italy; Fondazione CariPaRo, Padova, Italy; Fondazione Cariverona, Verona, Italy (A Scarpa); Ministero della Salute to Veneto Region, Rome, Italy; Ministero Università e Ricerca (FIRB-RBAP10AHJB), Italia. The authors are grateful to Deborah McGrath for her help in revising the manuscript.

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Authors and Affiliations

  1. Department of Surgery, University of Verona, Chirurgia Generale B, Policlinico “GB Rossi”, Piazzale LA Scuro, 37134, Verona, Italy

    Stefano Partelli, Stefano Crippa, Anna Neri, Claudio Bassi & Giuliano Barugola

  2. Department of Pathology, University of Verona, Piazzale LA Scuro, 37134, Verona, Italy

    Paola Capelli & Giuseppe Zamboni

  3. Dipartimento Chirurgia Pancreatica, Università Politecnica delle Marche, A.O.U. Ospedali Riuniti, Via Conca 71, 60126, Torrette-Ancona, Italy

    Massimo Falconi

Authors
  1. Stefano Partelli
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  2. Stefano Crippa
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  3. Paola Capelli
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  4. Anna Neri
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  5. Claudio Bassi
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  6. Giuseppe Zamboni
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  7. Giuliano Barugola
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  8. Massimo Falconi
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Corresponding author

Correspondence to Stefano Partelli.

Additional information

Stefano Partelli and Stefano Crippa contributed equally to the study.

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Partelli, S., Crippa, S., Capelli, P. et al. Adequacy of Lymph Node Retrieval for Ampullary Cancer and Its Association with Improved Staging and Survival. World J Surg 37, 1397–1404 (2013). https://doi.org/10.1007/s00268-013-1995-8

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  • DOI: https://doi.org/10.1007/s00268-013-1995-8

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