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Klein, Fritz; Jacob, Dietmar; Bahra, Marcus; Pelzer, Uwe; Puhl, Gero; Krannich, Alexander; Andreou, Andreas; Gül, Safak; Guckelberger, Olaf

Prognostic Factors for Long-Term Survival in Patients with Ampullary Carcinoma: The Results of a 15-Year Observation Period after Pancreaticoduodenectomy

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  • Media type: E-Article
  • Title: Prognostic Factors for Long-Term Survival in Patients with Ampullary Carcinoma: The Results of a 15-Year Observation Period after Pancreaticoduodenectomy
  • Contributor: Klein, Fritz; Jacob, Dietmar; Bahra, Marcus; Pelzer, Uwe; Puhl, Gero; Krannich, Alexander; Andreou, Andreas; Gül, Safak; Guckelberger, Olaf
  • imprint: Hindawi Limited, 2014
  • Published in: HPB Surgery
  • Language: English
  • DOI: 10.1155/2014/970234
  • ISSN: 0894-8569; 1607-8462
  • Origination:
  • Footnote:
  • Description: <jats:p><jats:italic>Introduction</jats:italic>. Although ampullary carcinoma has the best prognosis among all periampullary carcinomas, its long-term survival remains low. Prognostic factors are only available for a period of 10 years after pancreaticoduodenectomy. The aim of this retrospective study was to identify factors that influence the long-term patient survival over a 15-year observation period. <jats:italic>Methods</jats:italic>. From 1992 to 2007, 143 patients with ampullary carcinoma underwent pancreatic resection. 86 patients underwent pylorus-preserving pancreaticoduodenectomy (60%) and 57 patients underwent standard Kausch-Whipple pancreaticoduodenectomy (40%). <jats:italic>Results</jats:italic>. The overall 1-, 5-, 10-, and 15-year survival rates were 79%, 40%, 24%, and 10%, respectively. Within a mean observation period of 30 (0–205) months, 100 (69%) patients died. Survival analysis showed that positive lymph node involvement <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M1"><mml:mrow><mml:mfenced separators="|"><mml:mrow><mml:mi>P</mml:mi><mml:mo>=</mml:mo><mml:mn>0.001</mml:mn></mml:mrow></mml:mfenced></mml:mrow></mml:math>, lymphatic vessel invasion <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M2"><mml:mrow><mml:mfenced separators="|"><mml:mrow><mml:mi>P</mml:mi><mml:mo>=</mml:mo><mml:mn>0.0001</mml:mn></mml:mrow></mml:mfenced></mml:mrow></mml:math>, intraoperative administration of packed red blood cells <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M3"><mml:mrow><mml:mfenced separators="|"><mml:mrow><mml:mi>P</mml:mi><mml:mo>=</mml:mo><mml:mn>0.03</mml:mn></mml:mrow></mml:mfenced></mml:mrow></mml:math>, an elevated CA 19-9 <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M4"><mml:mrow><mml:mfenced separators="|"><mml:mrow><mml:mi>P</mml:mi><mml:mo>=</mml:mo><mml:mn>0.03</mml:mn></mml:mrow></mml:mfenced></mml:mrow></mml:math>, jaundice <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M5"><mml:mrow><mml:mfenced separators="|"><mml:mrow><mml:mi>P</mml:mi><mml:mo>=</mml:mo><mml:mn>0.04</mml:mn></mml:mrow></mml:mfenced></mml:mrow></mml:math>, and an impaired patient condition <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M6"><mml:mrow><mml:mfenced separators="|"><mml:mrow><mml:mi>P</mml:mi><mml:mo>=</mml:mo><mml:mn>0.01</mml:mn></mml:mrow></mml:mfenced></mml:mrow></mml:math> are strong negative predictors for a reduced patient survival. <jats:italic>Conclusions</jats:italic>. Patients with ampullary carcinoma have distinctly better long-term survival than patients with pancreatic adenocarcinoma. Long-term survival depends strongly on lymphatic nodal and vessel involvement. Moreover, a preoperative elevated CA 19-9 proved to be a significant prognostic factor. Adjuvant therapy may be essential in patients with this risk constellation.</jats:p>
  • Access State: Open Access