Outcome of pancreaticoduodenectomy and impact of adjuvant therapy for ampullary carcinomas

Lee, Jason H.; Whittington, Richard; Williams, Noel N.; Berry, Mark F.; Vaughn, David J.; Haller, Daniel G.; Rosato, Ernest F.

doi:10.1016/s0360-3016(00)00537-x

Cited by 97 publications

(79 citation statements)

References 23 publications

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“…Among them are absence of intraoperative transfusion, 2,5 absence of microscopic lymph node involvement, 1,2,5,13,19 well-differentiated tumors, 2,5,10,13 small tumor size, 14 absence of tumor at resection margins, 1,3,5 absence of perineural invasion, 4 confinement of tumor to the ampulla vs invasion into the pancreas, 4 and use of adjuvant chemotherapy. 4 In our series, the absence of perineural invasion predicted significantly improved postoperative survival.…”

Section: Commentmentioning

confidence: 99%

Improved Survival for Adenocarcinoma of the Ampulla of Vater

Duffy

Hines²,

Liu³

et al. 2003

Arch Surg

106

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After resection of an adenocarcinoma of the ampulla of Vater, certain clinical and pathologic characteristics influence long-term survival. Design: Retrospective case series. Setting: Major academic medical and pancreatic surgical center. Patients: Fifty-five consecutive patients who underwent Whipple resection for ampullary adenocarcinoma from 1988 through 2001. Interventions: Pylorus-preserving Whipple resection in 32 patients and standard Whipple resection in 23 patients. Main Outcome Measures: Postoperative survival. A multivariate Cox proportional hazards model was used to determine the effects of various factors on long-term survival after resection.Results: There were no operative deaths, and all patients left the hospital. After a mean follow-up of 46.9 months, the overall 5-year Kaplan-Meier survival estimate was 67.7%. The median survival of the entire group has not yet been reached. Five-year postoperative survival estimates for node-negative (n = 32) and nodepositive patients (n=23) were 76.5% and 53.4%, respectively (P = .26). Patients whose tumors demonstrated perineural invasion (n = 12) had a 5-year survival estimate of 29.2% vs 78.8% for those whose did not (PϽ.001). On multivariate analysis, the absence of perineural invasion (PϽ.001) was an independent predictor of significantly improved postoperative survival.

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Section: Commentmentioning

confidence: 99%

Improved Survival for Adenocarcinoma of the Ampulla of Vater

Duffy

Hines²,

Liu³

et al. 2003

Arch Surg

106

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“…Willett et al demonstrated 5-year OS of 55% for "high risk" disease (≥T3, poorly differentiated histologic findings, involved surgical margins or lymph nodes) and 80% survival for "low risk" disease (T1/T2 tumors without high risk features) (10). Similarly, several subsequent retrospective series reported similar survival, with 5-year OS of small patient subsets with T1-T2 disease, ranging from 40% to 100% (Table 2) (7,8,11,13,14). However, it is important to note that almost all of these studies included lymph node positive patients, with authors reporting outcomes based solely on T-staging without indication of nodal status or other adverse histologic features for these particular subsets.…”

Section: Discussionmentioning

confidence: 95%

“…Based on the results of these studies, adjuvant CRT has not been usually recommended for patients with T1/T2N0 disease (8,10,13). However, updated data from the National Cancer Data Base (Commission on Cancer of the American College of Surgeons and the American Cancer Society) from 1998-2002 reported 5-year OS of only 40% and 44% for T1N0 and T2N0 tumors, respectively (15).…”

Section: Discussionmentioning

confidence: 99%

“…Many authors recommend the use of adjuvant chemoradiotherapy (CRT) for patients with nodal involvement, involved margins and advanced tumor stage (8)(9)(10)(11)13). Published series advocate the use of adjuvant therapy in advanced tumors (i.e., T3/T4 and node positive disease) based on high locoregional recurrence and low OS rates reported in these patients.…”

Section: Introductionmentioning

confidence: 99%

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Patterns of Failure for Stage I Ampulla of Vater Adenocarcinoma: A Single Institutional Experience

Zhong¹,

Palta²,

Willett³

et al. 2013

International Journal of Radiation Oncology*Biology*Physics

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“…The trial will recruit 110 patients into each arm and will be completed by 2007 aiming to provide a definitive answer to the role of adjuvant regional therapy for pancreatic cancer. [53] 1993 26 45-55 20 18 Zerbi et al [21] 1994 43 12.5-20 1 9 71 7 4 7 1 2 49 10 Di Carlo et al [54] 1997 27 14 2 7 12.5-201 7 Dobelbower et al [55] 1997 [57] 1998 34 24 EBRT 13 EBRT + IOR 1 3 59 19 Klinkenbijl et al* [58] 1999 54pdc 12.6 10 60pdc 4 0 17.1 20 Mehta et al [59] 2000 52 45-54 8 IORT 32 75 38 Lee et al [60] 2000 22 47 1 3 4 9 81 EBRT = external beam radiotherapy; IORT = intraoperative radiotherapy; nm = nega tive resection margin; pm = positive resection margin; pdc = pancreatic ductal adenocarcinoma.…”

Section: Adjuvant Regional Therapymentioning

confidence: 99%

Adjuvant Therapy for Pancreatic Cancer

Sultana

Cox

Ghaneh

et al. 2012

Early Gastrointestinal Cancers

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The outlook for patients with pancreatic cancer has been grim. There have been major advances in the surgical treatment of pancreatic cancer, leading to a dramatic reduction in post-operative mortality from the development of high volume specialized centres. This stimulated the study of adjuvant and neoadjuvant t r e a t m e n t s i n p a n c r e a t i c c a n c e r i n c l u d i n g chemoradiotherapy and chemotherapy. Initial protocols have been based on the original but rather small GITSG study first reported in 1985. There have been two large European trials totalling over 600 patients (EORTC and ESPAC-1) that do not support the use of chemoradiation as adjuvant therapy. A second major finding from the ESPAC-1 trial (541 patients randomized) was some but not conclusive evidence for a survival benefit associated with chemotherapy. A third major finding from the ESPAC-1 trial was that the quality of life was not affected by the use of adjuvant treatments compared to surgery alone. The ESPAC-3 trial aims to assess the definitive use of adjuvant chemotherapy in a randomized controlled trial of 990 patients. Subject headingspancreatic neoplasms/drug therapy; pancreatic neoplasms/radiotherapy; human; review Ghaneh P, Slavin J, Sutton R, Hartley M, Neoptolemos JP.

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Outcome of pancreaticoduodenectomy and impact of adjuvant therapy for ampullary carcinomas

Cited by 97 publications

References 23 publications

Improved Survival for Adenocarcinoma of the Ampulla of Vater

Improved Survival for Adenocarcinoma of the Ampulla of Vater

Patterns of Failure for Stage I Ampulla of Vater Adenocarcinoma: A Single Institutional Experience

Adjuvant Therapy for Pancreatic Cancer

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