A proposal of an appropriate surgical approach for cancer of the ampulla of Vater: retrospective analysis of 73 resected cases

Abstract

Background/aims: Because early ampullary cancer has a good prognosis, less invasive surgery should be considered. But recent reports point out limitations of ampullectomy.

Methodology: Between April 1975 and March 2005, seventy-three patients with ampullary cancer were treated. The survival rates of different clinicopathologic features were analyzed retrospectively.

Results: Macroscopically, N(-) (negative lymph node metastasis), Panc(-) (no invasion of the pancreatic parenchyma) patients had a significantly longer 5-year survival rate than N(+) (positive lymph node metastasis), Panc(+) (invasion of the pancreatic parenchyma) patients (61.1% vs. 23.1%, 62.2% vs. 21.9%). Histologically, n(-), panc(-), and du(-) (no invasion of the duodenum) patients also had a significantly longer 5-year survival rate than n(+), panc(+), and du(+) (invasion of the duodenum) patients (63.3% vs. 21.1%, 64.3% vs. 29.8%, 83.3% vs. 36.8%, respectively). Patients with Panc(+), Du(+), mixed type and tumors other than the exposed type had significantly more lymph node metastases.

Conclusions: We propose PpPD and regional lymph node dissection as the reasonable operative method. If the tumor is preoperatively diagnosed as Panc(-), Du(-) and N(-), less invasive surgery may be indicated.