Radical pancreatoduodenectomy for cancer of the papilla of Vater
O. E. Akwari, J. A. van Heerden, M. A. Adson and A. H. Baggenstoss
Over a 22-year span, 87 patients with carcinoma of the papilla of Vater
underwent radical pancreatoduodenectomy. No patient was lost to follow-up,
and extended observation was possible in most cases: the definitive
operation was at least five years earlier than this study in 87% and at
least ten years earlier in 73%. Operative mortality was 11.5% among
patients who had a single definitive operative procedure and 15.4% among
those whose treatment involved reoperation after prior exploration
elsewhere. Overall survival rates at two, five, and ten years were 56%,
34%, and 20% respectively. Factors associated with favorable survival were
histologic differentiation (Broders grades 1 and 2), absence of nodal
metastasis, and papillary histologic characteristics. Noteworthy is the
fact that no patient having resection of an undifferentiated carcinoma
(Broders grade 3 or 4) survived four years.
