The clinical outcome of patients with ampullary carcinoma is more favorable than for patients with pancreatic head carcinoma. For both these diagnoses the Whipple procedure is the operation of choice, however, local resection may be recommended in some cases.
In this study, doctors from Sweden compared the outcome of local resection with that of pancreaticoduodenectomy.
The team retrospectively evaluated 92 patients with cancer of the ampulla of Vater, who were treated between 1975 and 1999. Of these 10 had local resection, 49 pancreatic resection, and 33 laparotomy and no resection.
They measured postoperative morbidity and mortality, surgical radicality, as well as long-term survival.
|There was no difference in long-term survival.|
The doctors found that the postoperative complication rate was significantly lower after local resection; however, mortality did not differ between the 2 resection groups.
They determined that UICC stages were less advanced in the local resection group. However, the frequency of positive resection margins and RO resections was the same in both groups.
There was no difference in long-term survival.
The team also found that local recurrence occurred in 80% of patients after local resection, compared with 22% after pancreatic resection.
Dr Gert Lindell's team concluded, "Pancreaticoduodenectomy is the preferred operation for cancer of the ampulla of Vater in patients who are fit for the procedure".
"Local resection plays a limited role in carefully selected patients".