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Periampullary adenocarcinomas, which include carcinomas of the bile duct, the ampulla of Vater, and the periampullary duodenum, are typically treated by surgical resection. Five-year survival rates following surgical resection rarely exceed 50%. To assess whether adjuvant chemotherapy might improve patient survival, Neoptolemos and colleagues randomly assigned 428 patients with surgically resected periampullary carcinomas to receive adjuvant chemotherapy (either fluorouracil plus folinic acid or gemcitabine) or no chemotherapy. The authors report that compared with no chemotherapy, treatment with gemcitabine or fluorouracil was not associated with a significant survival benefit. However, in analyses that adjusted for prognostic variables (patient age, tumor type and grade, and lymph node involvement), a survival benefit of chemotherapy was demonstrated.
This Week in JAMA. JAMA. 2012;308(2):109. doi:10.1001/jama.2012.3093
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