Abstract
BackgroundEarly ampullary cancers present with good prognosis. Pancreaticoduodenectomy (PD) has been standard treatment for ampullary cancers, but it remains high rate of postoperative complications. So there raises a discussion on the role of local ampullectomy for early ampullary cancers (mainly focusing on pT1).Methods89 patients with pT1 ampullary cancer who underwent surgical treatment between 1978 and 2010 were retrospectively studied.ResultsRate of postoperative complications, especially post-operative pancreatic fistula (P = 0.009), after PD was higher than after local ampullectomy, . Multivariate analysis showed that tumor size (HR 2.204; P = 0.014), lymph node metastasis (HR 4.362; P < 0.001), lymph vascular invasion (HR 4.258; P < 0.001), and perineural invasion (HR 4.467; P < 0.001), gross morphology (HR 2.536; P = 0.004) and tumor grade (HR 4.213; P = 0.001) were independent risk factors for long-term survival, as well as risk factors for failure of ampullectomy in early ampullary cancer. For patients absent of these factors, local ampullectomy would achieve a good prognosis.ConclusionsBecause of high rate of lymph node metastasis, PD should be preferably performed for radical resection. Local ampullectomy could be an alternative for patients in high operative risk; and would achieve a good outcome in patients whose tumors were well differentiated and showed polypoid gross morphology and size ≤1 cm.
Highlights
IntroductionPancreaticoduodenectomy (PD) has been standard treatment for ampullary cancers, but it remains high rate of postoperative complications
The pT1 stage meant that according to the seventh edition of the American Joint Committee on Cancer (AJCC), the tumor was confined to ampulla of Vater, As present study sought to examine the outcomes following surgical management of ampullary cancers, patients who had endoscopic excision of ampullary neoplasm were excluded from this study
Pre-operative staging As indicated in Table 1, the accuracy of Endoscopic ultrasound (EUS) in assessing the depth of carcinoma extension was 87.8% (72/82), superior to the magnetic resonance (MR) (67.0%, P < 0.001); The results of EUS in N staging of ampullary carcinomas were 65.9% (54/ 82), inferior to the MR (80.90%, P = 0.024)
Summary
Pancreaticoduodenectomy (PD) has been standard treatment for ampullary cancers, but it remains high rate of postoperative complications. There raises a discussion on the role of local ampullectomy for early ampullary cancers (mainly focusing on pT1). Recent literatures reported a 5-year survival rate ranging from 32% to 65%.[1,2,3,4,5] Pancreatoduodenectomy (PD), the standard surgical strategy for ampullary cancer, was still associated with high rate of postoperative complications, reaching to 33%-52%.[5,6] local ampullectomy had been attempted to be an alternative to PD for early cancer. First described by Halsted in 1899, was generally accepted in treatment of small benign tumors; but controversy still remained about expanding the indications to early ampullary cancers (mainly focusing on pT1) because of the high rate of recurrence.[6,7,8,9,10] because of the limited number of ampullary cancer patients, as regards to the surgical mode of early ampullary cancers, indications for performing local ampullectomy were not very clear and well-accepted
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
