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Fifty-five Consecutive Resections

John P. Duffy, MD; Oscar J. Hines, MD; Jerome H. Liu, MD; Clifford Y. Ko, MD; Galen Cortina, MD; William H. Isacoff, MD; Henry Nguyen, BS; Michael Leonardi, BS; Ronald K. Tompkins, MD; Howard A. Reber, MD

Arch Surg. 2003;138:941-950.

Hypothesis  After resection of an adenocarcinoma of the ampulla of Vater, certain clinical and pathologic characteristics influence long-term survival.

Design  Retrospective case series.

Setting  Major academic medical and pancreatic surgical center.

Patients  Fifty-five consecutive patients who underwent Whipple resection for ampullary adenocarcinoma from 1988 through 2001.

Interventions  Pylorus-preserving Whipple resection in 32 patients and standard Whipple resection in 23 patients.

Main Outcome Measures  Postoperative survival. A multivariate Cox proportional hazards model was used to determine the effects of various factors on long-term survival after resection.

Results  There were no operative deaths, and all patients left the hospital. After a mean follow-up of 46.9 months, the overall 5-year Kaplan-Meier survival estimate was 67.7%. The median survival of the entire group has not yet been reached. Five-year postoperative survival estimates for node-negative (n = 32) and node-positive patients (n = 23) were 76.5% and 53.4%, respectively (P = .26). Patients whose tumors demonstrated perineural invasion (n = 12) had a 5-year survival estimate of 29.2% vs 78.8% for those whose did not (P<.001). On multivariate analysis, the absence of perineural invasion (P<.001) was an independent predictor of significantly improved postoperative survival.

Conclusions  Compared with previous reports from our own and other centers, this series demonstrates improved postoperative survival by 10% to 20% in patients undergoing Whipple resection for adenocarcinoma of the ampulla of Vater. The reasons for this improved outcome are unclear, and the effect of adjuvant treatment cannot be determined from this analysis. The major factor associated with prolonged survival was the absence of perineural invasion in the resected tumor specimen.

From the Section of Gastrointestinal Surgery (Drs Duffy, Hines, Liu, Ko, Tompkins, and Reber, and Messrs Nguyen and Leonardi), and the Departments of Pathology (Dr Cortina) and Medicine (Dr Isacoff), the David Geffen School of Medicine at the University of California–Los Angeles.

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