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Pancreaticoduodenectomy cures node-negative ampullary cancer

June's issue of Archives of Surgery reports that pancreaticoduodenectomy is curative in 80% of patients with node-negative ampullary carcinomas, and long-term survival can be expected once 3-year survival is reached.

News image

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Dr Kimberly Brown and colleagues from Illinois considered the effects on survival following resection for ampullary carcinoma.

The investigators hypothesized that survival may be influenced by 1 or more clinical or pathologic variables.

The investigative team undertook a retrospective medical records review in an academic tertiary care center.

The team included 72 patients between 1991 through 2004, of which 31 were males and 41 were females.

The overall 5-year disease-specific survival is 58%
Archives of Surgery

The patients were treated for ampullary carcinoma at Loyola University Medical Center.

The team reported that of the 72 patients, 51 who underwent potentially curative pancreaticoduodenectomy were studied, with a median age of 69 years.

The intervention included whipple procedure for attempted cure in the 51 patients with ampullary adenocarcinoma.

The investigators main outcome measures were the effects of clinical and pathologic factors on disease-specific survival.

The data were analyzed using log-rank and a multivariate Cox proportional hazards model.

The investigative team found that median operative time was 6 hours, and median estimated blood loss was 800 mL.

The team observed that 30-day mortality was 2%.

The investigators noted that 27 had node-negative disease, 34 cases were T1/T2, and 23 were well differentiated.

The median follow-up for patients still alive was 42 months and the overall 5-year disease-specific survival was 58%.

The team found that 5-year survival was 78% in node-negative patients, 73% for T1/T2 patients, and 76% for well-differentiated tumors.

In comparison, the team noted that 5-year survival was 25% for node-positive, 8% for T3/T4, and 36% for poorly or moderately differentiated tumors.

On multivariate analysis, the team found that only node-negative disease maintained significance.

In all groups, the investigators observed no deaths due to disease after 3 years of survival was reached.

Dr Brown's team concluded, “Pancreaticoduodenectomy is curative in 80% of patients with node-negative ampullary carcinomas.”

“Once 3-year survival is reached, long-term survival can be expected.”

Arch Surg 2005: 140(6): 529
23 June 2005

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