Document Detail

Predictors of failure after pancreaticoduodenectomy for ampullary carcinoma.
MedLine Citation:
PMID:  16377504     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Complete resection offers the only potential cure for ampullary carcinoma. We analyzed factors that contribute to treatment failure and survival in patients who underwent pancreaticoduodenectomy for ampullary carcinoma. STUDY DESIGN: We retrospectively reviewed all patients who underwent pancreaticoduodenectomy between August 1994 and August 2003 for ampullary carcinoma. Demographic, clinical, and pathologic data were collected. Chi-square analysis was used for categorical data and the t-test was used for continuous variables. Kaplan-Meier analyses were compared using the log-rank test to examine patient survival. RESULTS: Forty-three patients (24 men) aged 63.7 +/- 11.4 years (standard deviation) were followed for a mean of 23.9 months (median 660 days, range 18 to 2,249 days). Jaundice (n = 33) and weight loss (n = 13) were the most common presenting symptoms. Stage (p < 0.01) and degree of differentiation (p < 0.029) were significant predictors of failure by univariate analysis. But only stage (p < 0.04) was a significant predictor by multivariate analysis. Further analysis revealed that nodal status (p < 0.001), but not tumor grade, was a significant predictor of treatment failure. Neither demographic nor clinical variables were significant predictors. Five-year overall and disease-free survival rates were 67.4% and 51.4%, respectively. Both metastases and disease recurrence had significant impact on patient survival. CONCLUSIONS: Tumor stage is associated with treatment failure after pancreaticoduodenectomy for ampullary carcinoma and may identify candidates for adjuvant therapy. Because an aggressive surgical approach can be adopted safely with the best chance for cure, we recommend that pancreaticoduodenectomy be offered to all patients with ampullary tumors when malignancy or dysplasia is in question.
Robin D Kim; Pavi S Kundhal; Ian D McGilvray; Mark S Cattral; Bryce Taylor; Bernard Langer; David R Grant; George Zogopoulos; Shimul A Shah; Paul D Greig; Steven Gallinger
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Publication Detail:
Type:  Journal Article     Date:  2005-10-20
Journal Detail:
Title:  Journal of the American College of Surgeons     Volume:  202     ISSN:  1072-7515     ISO Abbreviation:  J. Am. Coll. Surg.     Publication Date:  2006 Jan 
Date Detail:
Created Date:  2005-12-26     Completed Date:  2006-02-16     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9431305     Medline TA:  J Am Coll Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  112-9     Citation Subset:  AIM; IM    
Department of Surgery, Toronto General Hospital, University Health Network, Ontario, Canada.
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MeSH Terms
Adenocarcinoma / mortality,  pathology,  surgery*
Aged, 80 and over
Ampulla of Vater*
Common Bile Duct Neoplasms / mortality,  pathology,  surgery*
Middle Aged
Retrospective Studies
Risk Factors
Survival Rate
Treatment Failure

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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