Ann Surg Treat Res.  2020 Nov;99(5):259-267. 10.4174/astr.2020.99.5.259.

Predictors of early recurrence following a curative resection in patients with a carcinoma of the ampulla of Vater

• Ma CH
• Lee JH
• Song KB
• Hwang DW
• Kim SC

• KMID: 2508322
• DOI: http://doi.org/10.4174/astr.2020.99.5.259

Abstract

Purpose
Ampulla of Vater (AoV) carcinoma has a relatively good prognosis. The 5-year recurrence rate for AoV is still around 40%–50% however, and most recurrences occur in the early period. The aim of this study was to identify predictors of an early recurrence in AoV patients following a curative resection.
Methods
The clinicopathological data for 501 consecutive patients that underwent a resection for AoV in our institute between January 2000 and December 2015 were retrospectively reviewed. The characteristics of any recurrences and early recurrence patients were analyzed accordingly. Early recurrence was defined as occurring within one year of resection.
Results
There were 170 diagnosed recurrences in our study population, 57.1% of whom were men, with a mean age of 60.1 years (range, 30–94 years). Almost all of the study patients underwent a pancreaticoduodenectomy, and 9% underwent minimally invasive surgery. Of the 170 recurrent cases, 107 were diagnosed with an early recurrence and had 1-, 3-, and 5-year overall survival rates of 77.7%, 18.4%, 10.5%, respectively. The factors that significantly influenced early recurrences, determined by multivariate analysis, lymphovascular invasion (LVI), lymph node ratio (LNR), and poor differentiation were found to be independent determinants of a recurrence within 1 year.
Conclusion
An early recurrence in AoV patients is ultimately lethal even though this cancer has a good prognosis. LVI, LNR, and poor differentiation are powerful predictors of an early recurrence in AoV. Hence, intensive surveillance and new therapeutic strategies should be considered for AoV patients with these predictors following a curative resection.

Keyword

Ampulla of Vater; Early recurrence; Pancreaticoduodenectomy; Periampullary cancer

Figure

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  Fig. 1 Flow diagram of patient selection.

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  Fig. 2 (A) Kaplan-Meier survival curves after curative resection for ampulla of Vater cancer. (B) Kaplan-Meier survival curves for early and late recurrence patients.

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  Fig. 3 (A) Overall survival curve with and without adjuvant chemotherapy (CTx) among early recurrence group. (B) Overall survival curve with and without adjuvant CTx among late recurrence group.

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  Fig. 4 Patterns of recurrence after curative resection in the 170 recurred patients.

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