Gross Appearance of the Ampullary Tumor Predicts Lymph Node Metastasis and Outcome

Abstract

Background/Aims: Patterns of lymph node involvement in carcinoma of the papilla of Vater (CPV) have not been studied in detail to date, and factors associated with lymphatic metastases and surgical outcome of this disease remain to be determined. Methods: Lymph node involvement and surgical outcome of 51 CPV patients were evaluated by extended lymphadenectomy specimens. Results: Lymph nodes with high metastatic potential were posterosuperior pancreaticoduodenal nodes (group 13a, 18%), posterior-inferior pancreaticoduodenal nodes (group 13b, 22%), and nodes around the superior mesenteric artery (group 14, 18%). Gross appearance of the primary tumor and depth of tumor invasion correlated with lymph node involvement (p < 0.05, respectively). A correlation with positivity was also found in groups 13 and 14. Disease-specific survival correlated with the gross appearance of the primary tumor and nodal involvement. However, there was no relationship between survival and the level of nodal involvement. Multivariate analysis indicated that the gross appearance of the tumor was the only significant independent predictor of a poor outcome. Conclusions: Gross appearance of the tumor is the most important prognosticator of lymph node metastases in CPV. Nodal dissection around the superior mesenteric artery may improve survival except in patients without invasion of the sphincter of Oddi. Pylorus-preserving pancreaticoduodenectomy is the treatment of choice.

Proposed indications for limited resection of early ampulla of Vater carcinoma: clinico‐histopathological criteria to confirm cure

“…Determining whether or not tumor invasion is limited to mucosa before resection is very important, because patients with tumor invasion limited to the sphincter of Oddi may have nodal involvement. There have been some reports that patients with tumor invasion limited to the sphincter of Oddi did have nodal involvement [5, 9, 28, 29]. However, with regard to the extent of tumor invasion of the duodenum, it is impossible to completely discriminate between mucosa and the sphincter of Oddi even using EUS and IDUS preoperatively [20, 23, 25].…”

Epidemiologic Data, Tumor Size, Histologic Tumor Type and Grade, Pathologic Staging and Follow Up in Cancers of the Ampullary Region and Head of Pancreas in 311 Whipple Resection Specimens of Pakistani Patients

“…However, in our study, tumor size was not statistically significant (see results). A number of studies have also shown that tumor grade, stage, lymph node status and tumor size are important prognostic indicators which are closely and significantly associated with survival in these patients (Allema et al, 1995;Castro et al, 2004;Lazaryan et al, 2008;Morris-Stiff et al, 2009;Kayahara and Ohta, 2010;Qureshi et al, 2011;de Thomas and Ahmad, 2012). However, like in our study, tumor size was not seen to be significant in a study from Cleveland Clinic (Lazaryan et al, 2008).…”

“…The Whipple resection specimen includes the duodenum, head of pancreas, distal bile duct, and sometimes distal stomach. The following margins should be recognized and submitted for histopathologic examination when a specimen is received: common bile duct, pancreatic tissue, peripancreatic soft tissue and distal duodenal resection margins (Kayahara and Ohta, 2010). The pathological examination of Whipple resection specimens is important in evaluating multiple parameters which are prognostically important.…”

Prognostic Value of Excision Repair Cross-Complementing Gene 1, Dihydropyrimidine Dehydrogenase, and Human Equilibrative Nucleotide Transporter 1 Expression and Their Implications for Adjuvant Treatment in Patients With Ampullary Carcinoma

“…1,2,17,18 Significant molecular biomarkers with prognostic and predictive value for patients' survival can guide additional treatment strategies, such as selecting patients for adjuvant therapy with the maximum therapeutic benefit or stratifying patients in a prospective study; they also help to optimize the chemotherapeutic regimen for individual patients. Unfortunately, such useful biomarkers have not been elucidated in patients with AC.…”

“…1,2 Unfortunately, randomized controlled trials, including the ESPAC-3 trial, 3 have revealed that a fluorouracil (FU)-based or a gemcitabine (Gem)-alone regimen shows only a modest benefit as the primary adjuvant chemotherapy for resected ACs. On the other hand, the addition of platinum compounds, such as cisplatin, to a Gem-based regimen demonstrated an improvement in the survival of patients with unresectable locally advanced or metastatic biliary tract cancer including AC.…”