March 1991

Radical Resection for Carcinoma of the Ampulla of Vater

Author Affiliations

From the Departments of Surgery (Drs Monson, Donohue, McEntee, McIlrath, van Heerden, and Nagorney), Pathology (Dr Shorter), and Biostatistics (Mr Ilstrup), Mayo Clinic and Foundation, Rochester, Minn.

Arch Surg. 1991;126(3):353-357. doi:10.1001/archsurg.1991.01410270099016

• One hundred four consecutive patients who underwent radical resection for ampullary cancer between 1965 and 1989 were retrospectively reviewed. Frequent clinical findings included jaundice (67%), significant (>10%) weight loss (42%), and anemia (27%). Eighty-seven patients (84%) underwent a subtotal pancreatectomy, and 17 patients (16%) underwent a total pancreatectomy. The postoperative mortality was 5.7% (six patients), and reoperation for postoperative complications was required in six patients. The 5-and 10-year survival rates were 34% and 25%, respectively. Eight patients died of tumor recurrence more than 5 years after resection. Patient survival was significantly impaired by microscopic lymphatic invasion, regional nodal metastasis, tumor grade, and the epithelium of origin. In a multivariate analysis, only microscopic lymphatic invasion significantly reduced patient survival. Radical resection for ampullary cancer can be performed with a low morbidity and mortality and should remain the procedure of choice for ampullary carcinoma.

(Arch Surg. 1991;126:353-357)