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

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.