Histopathologic differentiation as a prognostic factor in patients with carcinoma of the hepatopancreatic ampulla of Vater

Abstract

ObjectivePeriampullary carcinomas are a group of neoplasms with variable histopathology that originate from the anatomical junction of different epithelial types including the bile duct, pancreatic duct, and duodenal mucosa. This study was performed to determine whether the histopathologic type of these tumors should be considered an independent prognostic factor.MethodsWe analyzed the specimen histopathology of 37 patients who underwent radical cephalic pancreatoduodenectomy for carcinoma of the ampulla of Vater during a 5-year period. We excluded patients with other tumors with an indication for Whipple’s procedure and those in whom R0 resection was not achieved.ResultsThe carcinomas of the hepatopancreatic ampulla were intestinal in 23 (62%) patients, pancreatobiliary in 13 (35%), and mixed type in 1 (3%). The analysis demonstrated significantly more advanced local tumor spread, a more aggressive lymph node metastasizing pattern, and more frequent lymphatic and perineural invasion in patients with pancreatobiliary than intestinal and mixed type tumors.ConclusionPancreatobiliary type of ampullary carcinoma is associated with a poorer prognosis than intestinal and mixed types because of its more aggressive behavior. Histopathology should be regarded as an independent predictor of survival and may have therapeutic and prognostic implications for patients.

Prognostic factors for long-term survival after pancreaticoduodenectomy for periampullary adenocarcinoma. A retrospective cohort study

“…Also, tumor differentiation has been reported to be associated with the progression of PAAC. Most studies in the multivariate analysis reported that poor tumor differentiation was a poor prognostic factor for survival [ 26 , 33 , 34 ], similarly, to what is seen in our series.…”

“…Other histopathological characters like lymph node metastasis and lymphovascular invasion should be regarded as an independent predictor of survival and may have therapeutic and prognostic implications for patients [ 11 , 33 , 34 ]. The poor OS reported in the study by Al-Jumayli et al, was likely due to the high rate of tumor invasion and extension [ 35 ].…”

Duodenopancreatectomia: análise histopatológica de tumores periampulares

“…O tipo pancreatobiliar é associado com prognóstico mais reservado do que o tipo intestinal devido a um comportamento mais agressivo. A diferenciação histopatológica deve ser vista como um preditor independente de sobrevida e deve ter implicações no tratamento desses doentes 13 .…”

Apparent diffusion coefficient-based histogram analysis differentiates histological subtypes of periampullary adenocarcinoma

“…However, due to the complexity of the periampullary region, misclassification of the original tumor site occurs in clinical practice[2]. Although resectable periampullary adenocarcinomas from different tumor origins are treated similarly by curative pancreatoduodenectomy (PD)[3], the prognosis varies considerably with a 5-year survival rate ranging from 34% to 66%[4]. Although improved outcome for patients with pancreatic adenocarcinoma receiving adjuvant chemotherapy has been demonstrated, the role of adjuvant therapy in nonpancreatic periampullary adenocarcinomas is less clear, which indicates the histological heterogeneity of the periampullary malignancy[5,6].…”

“…To better predict the prognosis of periampullary adenocarcinomas and to guide pre- and postoperative treatment, a classification based on histopathological subtype instead of anatomical origin was developed. Intestinal-type periampullary adenocarcinoma (IPAC) was reported to have a better prognosis than pan-creatobiliary-type periampullary adenocarcinoma (PPAC)[3,4,7-9]. Patients with IPAC had a median overall survival of 71.7 mo, while patients with PPAC had a median overall survival of only 33.3 mo[7].…”