Management and outcomes following pancreaticoduodenectomy for ampullary adenocarcinoma

M T Chavez; J P Sharpe; T O'Brien; K T Patton; D C Portnoy; N A VanderWalde; J L Deneve; D Shibata; S W Behrman; P V Dickson

doi:10.1016/j.amjsurg.2017.01.029

Management and outcomes following pancreaticoduodenectomy for ampullary adenocarcinoma

Am J Surg. 2017 Nov;214(5):856-861. doi: 10.1016/j.amjsurg.2017.01.029. Epub 2017 Jan 30.

Authors

M T Chavez¹, J P Sharpe¹, T O'Brien², K T Patton³, D C Portnoy⁴, N A VanderWalde⁵, J L Deneve¹, D Shibata¹, S W Behrman¹, P V Dickson⁶

Affiliations

¹ Department of Surgery, Division of Surgical Oncology, University of Tennessee Health Science Center, Memphis, TN, USA.
² Memphis Pathology Group, Memphis, TN, USA.
³ Pathology Group of the Midsouth, Germantown, TN, USA.
⁴ Division of Hematology/Oncology, University of Tennessee Health Science Center and West Cancer Center, Memphis, TN, USA.
⁵ Department of Radiation Oncology, University of Tennessee Health Science Center and West Cancer Center, Memphis, TN, USA.
⁶ Department of Surgery, Division of Surgical Oncology, University of Tennessee Health Science Center, Memphis, TN, USA. Electronic address: pdickso1@uthsc.edu.

PMID: 28285709
DOI: 10.1016/j.amjsurg.2017.01.029

Abstract

Introduction: The purpose of this study was to evaluate outcomes following pancreaticoduodenectomy(PD) for ampullary adenocarcinoma(AAC).

Methods: We evaluated patients having undergone PD for AAC and the impact of clinical/histopathologic factors and adjuvant therapy(AT) on survival.

Results: 52 patients underwent potentially curative PD. Perineural and lymphovascular invasion were associated with decreased survival. There was no difference in survival between patients treated with PD vs. PD+AT, however, AT was more often administered to patients with N1 vs. N0 and stage II/III vs. I disease. Among patients receiving AT, we observed a trend towards improved survival when radiation was included. Recurrence occurred in 7/18(39%) stage I patients, only 2(7%) of which received AT.

Conclusion: AT did not improve survival, however was more commonly administered in advanced disease. Stage I patients had high recurrence rates but rarely received AT. Prospective evaluation of appropriate AT regimens and use in early stage patients should be considered.

Keywords: Adjuvant therapy; Ampullary adenocarcinoma; Pancreaticoduodenectomy; Prognosis.

MeSH terms

Adenocarcinoma / mortality
Adenocarcinoma / surgery*
Adult
Aged
Aged, 80 and over
Ampulla of Vater*
Common Bile Duct Neoplasms / mortality
Common Bile Duct Neoplasms / surgery*
Female
Humans
Male
Middle Aged
Pancreaticoduodenectomy*
Retrospective Studies
Survival Rate
Treatment Outcome