Prognostic Factors of Long-term Survival Following Radical Resection for Ampullary Carcinoma

Vilhordo, Daniel Weiss; Gregório, Cleandra; Valentini, Dirceu Felipe; Edelweiss, Maria Isabel Albano; Uchôa, Diego de Mendonça; Osvaldt, Alessandro Bersch

doi:10.1007/s12029-020-00479-9

Cited by 12 publications

(9 citation statements)

References 52 publications

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“…Therefore, further investigation should be conducted to clarify the significance of lymph node dissection in the stations 14 and 16. With respect to long-term outcomes following radical resection for ampullary carcinoma, OS and RFS in this study were relatively better than those of previous reports (1,10,11). In addition, better PRS was confirmed in the present study (12).…”

Section: Discussionsupporting

confidence: 66%

Prognostic Value of the Regional Lymph Node Station in Pancreatoduodenectomy for Ampullary Carcinoma

Takagi

Nagai

Umeda

et al. 2022

In Vivo

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Background/Aim: The optimal extent of lymph node dissection for ampullary carcinoma is controversial. The aim of this study was to investigate the efficacy of lymph node dissection for ampullary carcinoma. Patients and Methods: Between 2000 and 2020, a total of 75 patients undergoing radical resection for ampullary carcinoma were included. The efficacy index (EI) was calculated by multiplication of the frequency of lymph node metastasis (LNM) at the station and the 5-year survival rate of patients with metastasis at the station. Results: Out of 75 patients, 14 had LNM. The EI for the peri-pancreatic head (station 13 and 17) and superior mesenteric artery (station 14) lymph node were 4.4 and 3.5, respectively. Whereas the peri-gastric (station 5 and 6), common hepatic artery (station 8), and liver hilum (station 12) lymph node stations had zero EI. Although the number of patients with the station 16 dissected was small (9%), the para-aortic (station 16) lymph nodes had the highest EI of 14.3 despite being distant lymph nodes. Conclusion: We identified the distribution of LNM and survival benefit of lymph node dissection for ampullary carcinoma. Our results suggest that the optimal extent of lymph node dissection for ampullary carcinoma could be reconsidered.Ampullary carcinoma of the duodenum, or carcinoma of the papilla of Vater, is a rare malignant neoplasm arising from the region of Vater's ampulla. Radical resection with pancreatoduodenectomy is the standard treatment for ampullary carcinoma (1); however, the significance of the optimal lymph node dissection on outcomes remains unclear. Although the Japanese guideline for ampullary carcinoma has proposed the optimal extent of lymph node dissection (2), the impact of the lymph node station dissected on the prognostic survival benefit is still unknown (3). Furthermore, data on long-term outcomes such as survival and recurrence patterns are limited (4, 5).The efficacy index (EI) has been proposed as a useful index to evaluate the therapeutic value of lymph node dissection for gastric cancer (6), and validated for various gastrointestinal and hepatopancreatobiliary cancers (7-9). However, to date, the impact of lymph node dissection on outcomes using the EI has not yet been examined in patients following radical resection for ampullary carcinoma.The aim of this study was to evaluate the efficacy of lymph node dissection using the EI as well as to determine the optimal extent of lymph node dissection for ampullary carcinoma. Moreover, long-term outcomes including survival and recurrence patterns were investigated. Patients and MethodsPatients and study design. The study protocol was approved by the Ethics Committee at our institution (approval no. 2110-003) and conducted according to the Declaration of Helsinki. We performed a retrospective review of the clinical database including 75 patients who underwent radical resection with pancreatoduodenectomy for ampullary carcinoma at the

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Section: Discussionsupporting

confidence: 66%

Prognostic Value of the Regional Lymph Node Station in Pancreatoduodenectomy for Ampullary Carcinoma

Takagi

Nagai

Umeda

et al. 2022

In Vivo

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“…In fact, hilar invasion of ampullary cancer was not observed in this study. In past reports that have described the results of treatment or surgery for ampullary cancer, pancreaticobiliary type, lymph node metastasis, advanced T stage, and large tumors were identi ed as risk factors for poor prognosis [36][37][38][39][40][41]. Hilar biliary invasion was not listed as a risk factor in these reports.…”

Section: Discussionmentioning

confidence: 98%

Screening for Hilar Biliary Invasion in Ampullary Cancer Patients

Sugimoto¹,

Takagi²,

Suzuki³

et al. 2021

Preprint

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Background: The treatment for ampullary cancer is pancreatoduodenectomy or local ampullectomy. However, effective methods for the preoperative investigation of hilar biliary invasion in ampullary cancer patients have not yet been identified. In this study, we aimed to determine an appropriate method for investigating hilar biliary invasion of ampullary cancer.Methods: Among 43 ampullary cancer patients, 34 underwent endoscopic treatment (n = 9) or surgery (n = 25). Imaging findings (thickening and enhancement of the bile duct wall on contrast-enhanced CT (CECT), irregularity on endoscopic retrograde cholangiography (ERC), thickening of the entire bile duct wall on intraductal ultrasonography (IDUS), and partial thickening of the bile duct wall on IDUS) and biliary biopsy results were compared with respect to their ability to diagnose hilar biliary invasion of ampullary cancer.Results: Hilar invasion was not observed in every patient. Among the patients who did not undergo biliary stent insertion, the combination of partial thickening of the bile duct wall on IDUS and biliary biopsy showed the highest accuracy (100%) for diagnosing biliary invasion. However, each imaging finding and biliary biopsy yielded some false positive results.Conclusions: Although some false positive results were obtained with each method, the combination of partial thickening of the bile duct wall on IDUS and biliary biopsy was useful for diagnosing hilar biliary invasion of ampullary cancer. However, hilar invasion of ampullary cancer is rare; therefore, the investigation of hilar biliary invasion of ampullary cancer might be unnecessary.Trial registration: not applicable

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“…In addition, the multivariate model demonstrated that high serum CA 19-9, perineural invasion, and the pancreatobiliary-types were independently associated with poor survival, a finding that concurs with previous reports ( 6 – 8 ). For instance, Vilhordo and colleagues ( 9 ) discovered the four prognostic factors of lymph node metastasis number, lymph node ratio (LNR), lymphovascularization, and differentiation grade of invasion. Numerous reports ( 10 , 11 ) have also reported that the histological type is associated with overall survival, implicating poor prognosis for the pancreaticobiliary-type, as observed in our cohort.…”

Section: Discussionmentioning

confidence: 99%

Clinicopathological Prognostic Factors and Chemotherapeutic Outcome for Two Histopathological Types of Ampulla of Vater Adenocarcinoma

Tao

Mou

et al. 2021

Front. Oncol.

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BackgroundAdenocarcinoma of the ampulla of Vater (AAV) is standardly treated using a complex operation, a pancreatoduodenectomy (PD), to remove the tumor. However, dicision-making in AAV clinical treatment remains difficult due to the broad range of AAV types, outcomes, and responses to special chemotherapeutics. Thus, this study aimed to explore clinicopathological prognostic factors associated with overall survival, as well as post-chemotherapeutic effects related to curative resection of AAV.MethodsWe retrospectively reviewed data for clinicopathological outcome of 47 patients diagnosed with AAV that had underwent a PD. Overall survival probabilities were obtained using the Kaplan–Meier estimate method and a Cox proportional hazards model.ResultsForty-five patients underwent LPD (laparoscopic pancreatoduodenectomy) and two patients underwent PD. The patient group was composed of 31 males (66%) and 16 females (34%) with a mean age of 65(34–91)years. We selected 45 patients for long-term survival analysis. One- and three-year overall survival rates after resection were 97.6% and 58.9% respectively. The median survival was 37.7 months for the intestinal-type and 26.9 months in pancreatobiliary-type ampullary tumors. Serum carbohydrate antigen (CA) 19-9 greater than 37 U/ml (HR 0.140, P = 0.007), perineural invasion (HR 0.141, P = 0.003), and classification as pancreatobiliary-type (HR 6.633, P = 0.006) were independently associated with poor survival. Serum carcinoembryonic antigen (CEA) greater than 5 µg/ml (P = 0.031), serum CA 19-9 greater than 37 U/ml (P = 0.002), tumor sizes greater than 2.5cm (P=0.002), and positive perineural invasion (P=0.003) were all associated with a poor prognosis in the histopathological subgroup. Serum CA 19-9 greater than 37 U/ml (P=0.002) and positive perineural invasion (P=0.001) were significantly associated with poor survival in of patients with intestinal-type ampullary tumors. Serum CEA greater than 5 µg/ml (P=0.013) and tumor sizes greater than 2.5cm (P=0.002) were significantly associated with poor survival in patients with pancreatobiliary-type ampullary tumors.ConclusionsPancreatobiliary-type ampullary tumors were associated with poor survival. Serum CA 19-9 in the intestinal-type and CEA in the pancreatobiliary-type were significantly associated with poor survival. Ajuvant chemotherapy could not predict the survival of AAV patients.

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Prognostic Factors of Long-term Survival Following Radical Resection for Ampullary Carcinoma

Cited by 12 publications

References 52 publications

Prognostic Value of the Regional Lymph Node Station in Pancreatoduodenectomy for Ampullary Carcinoma

Prognostic Value of the Regional Lymph Node Station in Pancreatoduodenectomy for Ampullary Carcinoma

Screening for Hilar Biliary Invasion in Ampullary Cancer Patients

Clinicopathological Prognostic Factors and Chemotherapeutic Outcome for Two Histopathological Types of Ampulla of Vater Adenocarcinoma

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