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Kimberly M. Brown, MD; Andrew J. Tompkins; Sherri Yong, MD; Gerard V. Aranha, MD, FRCSC; Margo Shoup, MD

Arch Surg. 2005;140:529-533.

Hypothesis  Survival following resection for ampullary carcinoma may be influenced by 1 or more clinical or pathologic variables.

Design  Retrospective medical records review.

Setting  Academic tertiary care center.

Patients  From July 1, 1991, through April 30, 2004, 72 patients (31 males and 41 females) were treated for ampullary carcinoma at Loyola University Medical Center, Maywood, Ill. Of these, 51 patients who underwent potentially curative pancreaticoduodenectomy were studied.

Interventions  Whipple procedure for attempted cure in 51 patients with ampullary adenocarcinoma.

Main Outcome Measures  The effects of clinical and pathologic factors on disease-specific survival were analyzed using log-rank and a multivariate Cox proportional hazards model.

Results  The median age of the 51 patients (25 males and 26 females) was 69 years (age range, 38-90 years). Median operative time was 6 hours (range, 4-12 hours), and median estimated blood loss was 800 mL (range, 350-7500 mL). Thirty-day mortality was 2% (1 of 51 patients). Twenty-seven had node-negative disease, 34 cases were T1/T2, and 23 were well differentiated. Median follow-up for patients still alive was 42 months (range, 2-147 months); overall 5-year disease-specific survival was 58%. Five-year survival was 78% (21/27) in node-negative patients, 73% (25/34) for T1/T2 patients, and 76% (17/23) for well-differentiated tumors compared with 25% for node-positive, 8% for T3/T4, and 36% for poorly or moderately differentiated tumors (P<.01). On multivariate analysis, only node-negative disease maintained significance (hazard ratio, 5.2; 95% confidence interval, 1.2-21.9). In all groups, there were no deaths due to disease after 3 years of survival was reached.

Conclusion  Pancreaticoduodenectomy is curative in 80% of patients with node-negative ampullary carcinomas. Once 3-year survival is reached, long-term survival can be expected.

Author Affiliations: Department of Surgery, Section of Surgical Oncology (Drs Brown, Aranha, and Shoup and Mr Tompkins) and Department of Pathology (Dr Yong), Loyola University Medical Center, Maywood, Ill.

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