Nodal Microinvolvement in Patients with Carcinoma of the Papilla of Vater Receiving No Adjuvant Chemotherapy

Choi

Korean J Hepatobiliary Pancreat Surg

et al. 2011

Backgrounds/AimsBecause of low incidence rates, there have been few reports on the patterns of and risk factors for recurrence after curative resection of the ampulla of Vater (AoV) cancer. The aim of this study was to characterize patterns of recurrence and to evaluate risk factors affecting survival rates and recurrence after curative resection.MethodsMedical records of 181 patients who had undergone pancreaticoduodenectomy with curative intent for AoV adenocarcinoma between December 1994 and March 2010 at Samsung Medical Center were retrospectively reviewed. Factors influencing on overall survival rate, recurrence rates, and recurrence patterns were analyzed.ResultsLymph node metastases and high preoperative serum carcinoembryonic antigen (CEA) level >5 ng/ml were identified as independent factors affecting overall survival (p=0.006, p<0.001, respectively). Among the 181 patients, 69 developed local or distant recurrence within 3 years after curative resection. Lymph node metastasis, preoperative serum CEA level >5 ng/ml, and total bilirubin level >1.5 mg/dl were identified as independent prognostic factors of recurrence after curative resection (p=0.008, p<0.001, p=0.003, respectively).ConclusionsAoV adenocarcinoma has a better prognosis than other periampullary carcinomas, but still has a high recurrence rate, especially during the first three years after curative radical resection. Therefore, careful follow-up is needed during the first 3 years, especially for the higher risk group. Further study of adjuvant therapy to decrease recurrence after curative resection is now warranted.

Section: Discussionmentioning

confidence: 69%

Section: Discussionmentioning

confidence: 99%

Adenocarcinoma of the ampulla of Vater: predictors of survival and recurrence after curative radical resection

Choi

Korean J Hepatobiliary Pancreat Surg

et al. 2011

“…It has been reported the rate of lymph node metastasis (LNM) ranges from 20% to 50% (1). Despite many clinicopathologic characters are associated with prognosis for AC patients, LNM is still one of the most crucial risk factors (1,(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25).…”

Section: Introductionmentioning

confidence: 99%

Development and Validation of a New Lymph Node Ratio-Based Staging System for Ampullary Carcinoma After Curative Pancreaticoduodenectomy

Zhang

Sun

et al. 2022

Front. Oncol.

BackgroundLymph node metastasis (LNM) is closely associated with the prognosis of ampullary carcinoma (AC). The purpose of this study is to explore the relationship between lymph node ratio (LNR) and the prognosis of patients with AC after curative pancreaticoduodenectomy and to establish a new LNR-based staging system.MethodsAC patients in the Cancer Hospital, Chinese Academy of Medical Sciences, between 1998 and 2020 were retrospectively reviewed as the training cohort; and AC patients in the Surveillance, Epidemiology, and End Results (SEER) database between 2010 and 2018 were obtained as the validation cohort. Within the training group, Kaplan–Meier survival analyses and Cox proportional hazards regression were conducted to assess the prognostic value of LNR and establish a new LNR-based staging system. Then, the new staging system was compared with the 8th American Joint Committee on Cancer (AJCC) TNM staging system in both the training and validation cohorts.ResultsA total of 264 patients in the training cohort and 199 patients in the validation cohort were enrolled. Significant overall survival (OS) difference was observed between LNR-low stage and LNR-high stage in both training (p = 0.001) and validation cohorts (p < 0.001). Then a new LNR-based staging system was developed. Under the new system, the number of patients in the training cohort and validation cohort of stage I, stage II, and stage III was 30 (11%) vs. 18 (9%), 190 (72%) vs. 96 (48%), and 44 (17%) vs. 85 (43%), respectively. The new staging system classified patients with respect to survival better than did the 8th AJCC TNM staging system.ConclusionsThe new LNR-based staging system had better discriminability for predicting survival in AC patients after curative pancreaticoduodenectomy. More data are needed for further validation.

“…Carcinoma of the papilla of Vater (CPV) accounts for about 0.6% of all gastrointestinal carcinomas, so it is a very rare tumor (1). Nodal involvement is the main pattern of tumor spread and is known as one of most important factors related to poor prognosis in CPV (2)(3)(4)(5). Therefore, lymphadenectomy play an important role in radical resection.…”

Section: Introductionmentioning

confidence: 99%

“…Because of the low incidence of CPV, the previous studies that have focused on prognostic factors in CPV had small sample sizes and varying conclusions (3)(4)(5)12,13). The prognostic factors for CPV remain controversial.…”

Section: Introductionmentioning

confidence: 99%

Choice of surgical procedures for patients with stage T1 carcinoma of the papilla of Vater: a retrospective study

Gu¹,

Li²,

Yu³

et al. 2020

Transl Cancer Res TCR

Background: Given the high incidence of complications after pancreaticoduodenectomy (PD), local resection is being applied to cure stage T1 carcinoma of the papilla of Vater (CPV). In the present study, risk factors related to nodal involvement and prognosis were evaluated so as to enable the choice of optimal surgical procedure for patients with stage T1 CPV.Methods: A retrospective study of 94 consecutive patients with CPV who underwent PD in our center from 2013 to 2018 was conducted.Results: A total of 44 patients (46.8%; 44 of 94) had lymph node metastasis. T1 tumors were subdivided into layer I (the mucosa) and layer II (the submucosa) based on anatomical stratification, and lymph node metastasis did not occur in patients with layer I invasion. The nodal metastasis rate was up to 25% (6 of 24) in patients with layer II invasion. The gross appearance, depth of duodenal invasion, pT stage and perineural invasion were risk factors related to nodal involvement. Only the depth of duodenal invasion remained a significant independent factor (P=0.003). Multivariate Cox analysis indicated that depth of duodenal invasion (P=0.001), nodal involvement (P<0.001), and venous invasion (P<0.001) were independent prognostic factors. The depth of duodenal invasion is the only independent risk factor related to nodal involvement and prognosis. Conclusions:The optimal surgical option should be PD with radical lymphadenectomy for patients with stage T1 CPV; only patients with duodenal invasion limited to the mucosa are suitable for local resection. A modified T category needs to be proposed based on the detailed depth of duodenal invasion.