Korean J Hepatobiliary Pancreat Surg.  2011 Aug;15(3):171-178. 10.14701/kjhbps.2011.15.3.171.

Adenocarcinoma of the ampulla of Vater: predictors of survival and recurrence after curative radical resection

• Kim KJ
• Choi DW
• Kim WS
• Kim MJ
• Song SC
• Heo JS
• Choi SH

• KMID: 2130989
• DOI: http://doi.org/10.14701/kjhbps.2011.15.3.171

Abstract

BACKGROUNDS/AIMS
Because of low incidence rates, there have been few reports on the patterns of and risk factors for recurrence after curative resection of the ampulla of Vater (AoV) cancer. The aim of this study was to characterize patterns of recurrence and to evaluate risk factors affecting survival rates and recurrence after curative resection.
METHODS
Medical records of 181 patients who had undergone pancreaticoduodenectomy with curative intent for AoV adenocarcinoma between December 1994 and March 2010 at Samsung Medical Center were retrospectively reviewed. Factors influencing on overall survival rate, recurrence rates, and recurrence patterns were analyzed.
RESULTS
Lymph node metastases and high preoperative serum carcinoembryonic antigen (CEA) level >5 ng/ml were identified as independent factors affecting overall survival (p=0.006, p<0.001, respectively). Among the 181 patients, 69 developed local or distant recurrence within 3 years after curative resection. Lymph node metastasis, preoperative serum CEA level >5 ng/ml, and total bilirubin level >1.5 mg/dl were identified as independent prognostic factors of recurrence after curative resection (p=0.008, p<0.001, p=0.003, respectively).
CONCLUSIONS
AoV adenocarcinoma has a better prognosis than other periampullary carcinomas, but still has a high recurrence rate, especially during the first three years after curative radical resection. Therefore, careful follow-up is needed during the first 3 years, especially for the higher risk group. Further study of adjuvant therapy to decrease recurrence after curative resection is now warranted.

Keyword

Ampulla of Vater; Adenocarcinoma; Pancreaticoduodenectomy; Prognosis; Recurrence

MeSH Terms

Adenocarcinoma
Ampulla of Vater
Bilirubin
Carcinoembryonic Antigen
Follow-Up Studies
Humans
Incidence
Lymph Nodes
Medical Records
Neoplasm Metastasis
Pancreaticoduodenectomy
Prognosis
Recurrence
Retrospective Studies
Risk Factors
Survival Rate
Bilirubin
Carcinoembryonic Antigen

Figure

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  Fig. 1 Kaplan-Meier survival curve after curative resection for ampullary adenocarcinoma

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  Fig. 2 Kaplan-Meier disease-free survival curve after curative resection for ampullary adenocarcinoma.

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