Is local resection adequate for T1 stage ampullary cancer? HPB (Oxford) 2015 Jan;17(1):66-71
Date
11/15/2014Pubmed ID
25395092Pubmed Central ID
PMC4266442DOI
10.1111/hpb.12297Scopus ID
2-s2.0-84915822122 (requires institutional sign-in at Scopus site) 38 CitationsAbstract
BACKGROUND: Concerns for morbidity after a pancreaticoduodenectomy (PD) has led to practitioners adopting endoscopic resection or ampullectomy in the treatment of T1 ampullary cancer (AC). It was hypothesized that survival for patients undergoing local resection of AC was inferior to those undergoing a PD.
METHODS: All the data of patients with AC reported in the Surveillance, Epidemiology and End Results (SEER) database between 2004 and 2010 were collected. Five-year survival rates according to nodal disease and histological type were compared.
RESULTS: There were 1916 cases of AC; 421 (22%) had T1 disease. Among those with T1 disease, 217 (51%) received endoscopic surveillance, 21 (5%) underwent local resection/ampullectomy, 20 (5%) underwent ampullectomy with regional lymphadenectomy and 163 (39%) underwent PD. For patients with complete nodal staging (PD, n = 163), 35 (22%) had metastatic disease in the nodes. Grade was significantly associated with node positivity (P = 0.007). In multivariate models, survival was improved with either an ampullectomy with regional lymphadenectomy [hazard ratio (HR) 0.19; 95% confidence interval (CI) 0.05-0.61, P < 0.005] or a PD (HR 0.23; 95% CI 0.15-0.36, P < 0.001).
CONCLUSION: Patients with T1 AC have a high risk for nodal metastases especially if they are higher-grade lesions. Nodal clearance with a lymphadenectomy or a PD is essential for long-term survival in these patients.
Author List
Amini A, Miura JT, Jayakrishnan TT, Johnston FM, Tsai S, Christians KK, Gamblin TC, Turaga KKAuthor
Kathleen K. Christians MD Professor in the Surgery department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AdenocarcinomaAged
Aged, 80 and over
Ampulla of Vater
Common Bile Duct Neoplasms
Endoscopy, Digestive System
Female
Humans
Kaplan-Meier Estimate
Lymph Node Excision
Lymphatic Metastasis
Male
Middle Aged
Neoplasm Staging
Pancreaticoduodenectomy
Predictive Value of Tests
Proportional Hazards Models
Retrospective Studies
Risk Factors
SEER Program
Survival Rate
Time Factors
Treatment Outcome
United States
Watchful Waiting
