Prognostic value of the lymph node metastasis in patients with ampulla of Vater cancer after surgical resection

Abstract

Backgrounds/Aims: Patients with Ampulla of Vater cancer have a better prognosis than those with other periampullary cancers. This study aimed to determine the prognostic impact of lymph node metastasis on survival in patients with ampulla of Vater cancer after surgical resection. Methods: From 1991 to 2016, we retrospectively reviewed data on 104 patients with ampulla of Vater cancer who had received pancreaticoduodenectomy. Clinicopathologic factors such as lymph node ratio (LNR) and number of metastatic lymph nodes that influence survival were statistically analyzed. Results: 5-year survival rate after resection was 57.8%. Mean number of retrieved and metastatic lymph nodes was 13 and 0.95, respectively. In patients with lymph node metastasis, the median number of metastatic lymph nodes and was 1, and the mean LNR was 0.18. LNR ＞0.2 was a significant prognostic factor for overall survival. Patients with 0 or 1 metastatic lymph nodes had better survival than those with ≥2 metastatic lymph nodes. Univariate analysis revealed that histologic differentiation of tumor, lymph node metastasis, and T stage were significant prognostic factors for overall survival. Multivariate analysis revealed that tumor differentiation and number of metastatic lymph nodes were independent prognostic factors for survival. Conclusions: Pancreaticoduodenectomy is an appropriate surgical procedure with acceptable long-term survival for ampulla of Vater cancer. Patients with LNR ＞0.2 and ≥2 positive lymph node metastasis had a poor survival. Tumor differentiation and ≥2 metastatic lymph nodes were independent significant prognostic factors for overall survival. Curative resection with lymph node dissection might control lymph node spread and enhance survival outcomes.

Differences in Lymph Node Metastases Patterns Among Non-pancreatic Periampullary Cancers and Histologic Subtypes: An International Multicenter Retrospective Cohort Study and Systematic Review

“…Lymph node metastases in pancreatic cancer and periampullary cancer are associated with reduced survival rates. 10 , 13 , 14 Nevertheless, the clinical relevance of lymph node metastases in each of the lymph node stations in the peripancreatic region requires further evaluation. This study evaluated the individual impact of metastases in each lymph node station on overall survival while accounting for the NPPC tumor type.…”

“… 10 – 12 A critical determinant of a worse prognosis for NPPC, influencingthe decision for adjuvant treatment, is lymph node metastases. 10 , 13 , 14 Therefore, adequate lymphadenectomy and pathologic assessment of the resected lymph nodes is crucial for accurate staging and has an impact on postoperative treatment methods such as chemotherapy.…”

Duodenaladenome und -karzinome: chirurgische Therapiekonzepte

“…Ziel laut Leitlinie für Pankreaskarzinome sollte die Entfernung von 12 Lymphknoten sein 36 . Grundsätzlich ist das Auftreten von Lymphknotenmetastasen mit einer schlechteren Prognose vergesellschaftet 37 , 38 . Gegenstand aktueller Diskussion ist die Bedeutung der erweiterten Lymphadenektomie gegenüber dem Standard.…”