Limitations of ampullectomy in the treatment of nonfamilial ampullary neoplasms Journal Article
| Authors: | Roggin, K. K.; Yeh, J. J. J.; Ferrone, C. R.; Riedel, E.; Gerdes, H.; Klimstra, D. S.; Jaques, D. P.; Brennan, M. F. |
| Article Title: | Limitations of ampullectomy in the treatment of nonfamilial ampullary neoplasms |
| Abstract: | Background: Pancreaticoduodenectomy (PD) is the standard surgical management of invasive ampullary neoplasms. A rational plan to use ampullectomy (AMP) for lesions at this location requires careful analysis of preoperative clinical information (comorbidity, lesion size, and histopathology) and intraoperative data (frozen section pathology and clinical impression) to properly select patients for this treatment. Methods: We identified 140 consecutive cases of nonfamilial ampullary neoplasms from our prospective institutional database over a 7-year period (1996-2003). Preoperative and intraoperative factors were analyzed and related to outcomes. Results: AMP was planned for 37 patients with small lesions (median, 1.86 cm [range, 0-3 cm] vs. 2.6 cm [range, 0-8 cm] in PD). AMP was converted to PD because of the extent of disease in three and an intraoperative diagnosis of invasive cancer in five patients. Preoperative biopsy had a diagnostic accuracy of 79% (97 of 123) but missed 23 cancers. Intraoperative frozen section had a diagnostic accuracy of 84%; two cases of high-grade dysplasia and invasive cancer were missed. Patients with invasive cancer treated by AMP had a decreased recurrence-free and disease-specific survival compared with those treated by PD. Lymphatic spread of disease was associated with diminished long-term survival. Although both vascular invasion and tumor stage independently predicted lymphatic metastases, both were limited by their sensitivity. Conclusions: The reduced morbidity and mortality of AMP makes this the preferred treatment for benign lesions of the ampulla. Conversion to PD should be considered when intraoperative or final pathology identifies invasive adenocarcinoma. Refinement of clinicopathologic factors may reduce the occasional PD for benign disease and AMP for malignancy. © 2005 The Society of Surgical Oncology, Inc. |
| Keywords: | survival; adult; controlled study; human tissue; aged; aged, 80 and over; disease-free survival; middle aged; survival analysis; surgical technique; retrospective studies; major clinical study; mortality; pancreatic neoplasms; lymph node metastasis; lymphatic metastasis; neoplasm staging; prospective study; sensitivity and specificity; pancreaticoduodenectomy; adenocarcinoma; morbidity; tumor biopsy; pathology; data base; algorithms; cancer invasion; adenoma; recurrent disease; frozen section; frozen sections; dysplasia; vater papilla carcinoma; ampulla of vater; ampullectomy; periampullary neoplasms; nonfamilial ampullary neoplasm |
| Journal Title: | Annals of Surgical Oncology |
| Volume: | 12 |
| Issue: | 12 |
| ISSN: | 1068-9265 |
| Publisher: | Springer |
| Date Published: | 2005-11-01 |
| Start Page: | 971 |
| End Page: | 980 |
| Language: | English |
| DOI: | 10.1245/aso.2005.03.009 |
| PUBMED: | 16244798 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | --- - "Cited By (since 1996): 24" - "Export Date: 24 October 2012" - "CODEN: ASONF" - "Source: Scopus" |
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