Evaluation of Surgical Resection for Ampullar Carcinoma at Japanese Single Cancer Institute

Abstract

Aims: Surgical resection is the only radical treatment option for duodenal ampullar carcinoma (AC) that results in an improved patient prognosis. Method: We examined the demographics, surgical records, and outcome in 23 patients with AC undergoing pancreaticoduodenectomy (PD). Results: Of 23 patients, 17 underwent pylorus preserving PD (PPPD) and 6 underwent PD, including subtotal stomach-preserving PD in 5. D2 lymphadenectomy was performed in 17 patients and D3 lymphadenectomy was performed in 6. The combined resection of the superior mesenteric vein was performed in 1 patient. Postoperative cancer recurrence was observed in 32%, and 6 patients died of cancer. The 3-year tumor-free survival rates were not different between the final stages (p=0.64) and the 5-year cancer-related overall survival rates were not different between stages either (p=0.28). Tumor size≥3cm resulted in significantly poorer survival rate compared to smaller tumors (p=0.032). Node metastasis at Group 2, and moderately or poorly differentiated adenocarcinoma were significantly associated with poor survival (p<0.05); however, cancer infiltration at cut-end margin, degree of node dissection and curability were not associated with overall prognosis. Conclusions: Radical surgical resection showed good patient prognosis; however, new adjuvant chemotherapy is a promising modality to improve patient survival in AC patients with poor prognostic factors.