Pancreaticoduodenectomy is curative in the majority of patients with node-negative ampullary cancer

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 800mL (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.