Pancreaticoduodenectomy for Ampullary Carcinoma

Abstract

Thirty-two consecutive patients with adenocarcinoma of the ampulla of Vater who had curative resection by pancreaticoduodenectomy were analyzed to determine the accuracy of preoperative investigations and factors that influenced survival. Obstructive jaundice was present in 31 patients, and most patients had pain and weight loss. Ultrasound was more useful than CT in identifying biliary obstruction, whereas CT was more accurate in demonstrating pancreatic duct dilatation and an ampullary mass. Endoscopic retrograde cholangiopancreatography with biopsy and brush cytology was the most accurate investigation and proved or was suspicious of carcinoma in all patients. Nineteen patients had postoperative complications, three of whom died (9.4%)—two of sepsis and one from aspiration following hematemesis. Actuarial 5-year survival was 46 per cent. Stage of disease was the strongest predictor of survival. All patients with T1 lesions are alive more than 5 years after resection. Patients with lymph node metastases had a significantly shorter survival than node-negative patients (P = 0.00087). Pancreaticoduodenectomy is advocated for ampullary carcinoma in good-risk patients, with the anticipation of prolonged survival in those with early (T1) lesions and node-negative disease.

Jaundice at Presentation Heralds Advanced Disease and Poor Prognosis in Patients with Ampullary Carcinoma

“…Surgery is the treatment of choice for resectable stages of ampullary carcinoma [1][2][3][4][5]. The prognosis for patients with ampullary carcinoma is affected by lymph node metastasis, invasion into the pancreas, perineural invasion, and histologic grade, all of which can be assessed only after resection [1][2][3][6][7][8][9][10][11][12][13]. The ability to assess such prognostic indicators prior to resection would greatly improve the management of patients with ampullary carcinoma.…”

“…Although jaundice is a common manifestation of ampullary carcinoma, some patients present without jaundice [2, 3, 9, 13, 14]. The prognostic significance of jaundice at presentation has not been ascertained [9, 13, 14]. The association between jaundice and the degree of spread of ampullary carcinoma is also unknown.…”

Landscape of distant metastasis mode and current chemotherapy efficacy of the advanced biliary tract cancer in the United States, 2010‐2016

“…Obstructive jaundice might develop at an early stage in the DCC and the AVC, while the GBC and the PHCC are always symptom-free or just manifested by some nonspecific symptoms, such as sour regurgitation, nausea, and abdominal pain. 9 Pathological difference might be an important factor, because the GBC and the PHCC are always more malignant and have a higher recurrence rate and a higher mortality rate after resection. Adjacency to visceral organ and complex vascular lymphatic system might also play an important role.…”

“…About the differences of DM modes, there were some theoretical bases in clinical features and anatomy. Obstructive jaundice might develop at an early stage in the DCC and the AVC, while the GBC and the PHCC are always symptom‐free or just manifested by some nonspecific symptoms, such as sour regurgitation, nausea, and abdominal pain . Pathological difference might be an important factor, because the GBC and the PHCC are always more malignant and have a higher recurrence rate and a higher mortality rate after resection.…”

Impact of Reconstruction Methods on Outcome of Pancreatoduodenectomy in Pancreatic Cancer Patients

“…Local recurrence is one of the most frequent forms of pancreatic cancer recurrence, even after margin-negative resection [3,4]. In contrast, it has been reported that local recurrence is rare in patients who undergo pancreatoduodenectomy for distal duct cancer [5][6][7][8], ampullary cancer [9,10], or duodenal cancer [11][12][13][14]. Based on these reports, we can easily speculate that the type of reconstruction (the root of the alimentary tract) may affect the postoperative course of the patients.…”