Medline ® Abstracts for References 1-4
of 'Ampullary carcinoma: Epidemiology, clinical manifestations, diagnosis and staging'
Treatment and outcome in 52 consecutive cases of ampullary carcinoma.
Neoptolemos JP, Talbot IC, Carr-Locke DL, Shaw DE, Cockleburgh R, Hall AW, Fossard DP
Br J Surg. 1987;74(10):957.
The results of treatment and outcome in 52 consecutive patients presenting to Leicester from 1972 to 1984 are presented. The number of patients diagnosed increased from two per year before the introduction of duodenoscopy to nearly five per year afterwards. Endoscopic drainage (ED) was attempted in 21 patients with a success rate of 81 per cent. In eight cases ED was used pre-operatively and in the remainder as definitive treatment. Twenty-four patients had a Whipple's resection (12.5 per cent mortality), four patients had a local resection (no deaths), ten patients had surgical bypass (60 per cent mortality) and thirteen patients had ED alone (23 per cent mortality). The major risk factor score was significantly greater in patients undergoing surgical bypass compared with Whipple's resection. Age and risk factor scores were significantly greater in patients who had ED drainage alone than in surgical patients. The 5 year survival rate for resection was 56 per cent versus 13 per cent for drainage procedures (P less than 0.001). Survival in resection cases was directly related to the degree of tumour differentiation and a new staging system. It is proposed that all patients with ampullary tumours should have endoscopic biopsy followed by ED; Whipple's resection remains the surgical treatment of choice.
Leicester Royal Infirmary, UK.
Cancer of the ampulla of Vater: results of a 20-year population-based study.
Benhamiche AM, Jouve JL, Manfredi S, Prost P, Isambert N, Faivre J
Eur J Gastroenterol Hepatol. 2000;12(1):75.
BACKGROUND: Relatively little attention has been given to the epidemiology and management of cancer of the ampulla of Vater.
SETTING: A series of 111 patients with a cancer of the ampulla of Vater diagnosed over a 20-year period (1976-1995) in a well-defined French population was used to analyse its incidence, management and prognosis as well as to determine time trends. Prognosis was determined by using crude and relative survival rates. Factors predictive of survival were also identified using a relative survival model in a multivariate analysis.
RESULTS: Age-standardized incidence rates were 3.8 per 1000000 inhabitants in men and 2.7 per 1000000 inhabitants in women. Incidence increased over time in men from 1.9 during the first period (1976-1980) to 5.9 during the last period (1991-1995). In women, incidence rates remained stable. A resection for cure was performed in 52 cases (48.1%). Overall, 9.9% of these cancers were classified TNM stage I and 54.1% stage IV. There was no significant variation in treatment modalities and in stage at diagnosis over the study period. The overall operative mortality rate was 7.5%. Relative survival rates were 58.9% at 1 year, 30.9% at 3 years and 20.9% at 5 years. Five-year relative survival rates varied from 72.8% in TNM stage I cancers to 6.6% in TNM stage IV cancers. Age, treatment procedure and stage at diagnosis significantly influenced the prognosis of cancer of the ampulla of Vater. In a multivariate analysis, stage at diagnosis remained the major prognostic factor (P<0.01).
CONCLUSIONS: Although its incidence is increasing in men, cancer of the ampulla of Vater remains a rare tumour in both sexes. No improvements in the management and care of patients have been achieved. Further studies are needed to enhance the understanding of this cancer.
Registre Bourguignon des Cancers Digestifs (INSERM CRI 95 05), Facultéde Médecine, Dijon, France. Anne-Marie.Benhamiche@u-bourgogne.fr
Cancers of the ampulla of vater: demographics, morphology, and survival based on 5,625 cases from the SEER program.
Albores-Saavedra J, Schwartz AM, Batich K, Henson DE
J Surg Oncol. 2009;100(7):598.
BACKGROUND: Cancers of the ampulla are unusual and morphologically heterogeneous. The NCI's SEER Program is now large enough so that unusual cancers can be studied. Based on pathologic and epidemiologic characteristics of cancer of the ampulla available in SEER, important clinicopathological correlations can be made.
METHODS: All patients with cancer of the ampulla were identified between 1973 and 2005. Demographic features, distribution of histological types, age-specific incidence rates, and 5-year survival rates according to stage and histologic type were compared.
RESULTS: There were 5,625 cases of ampullary cancer. Ampullary cancer has been increasing since 1973. In both African Americans and Caucasians, the disease is more common in men. Adenocarcinomas, NOS comprised 65% of all histological types. Survival depends on stage, grade, and histologic type. Papillary carcinomas had a more favorable survival than other types; carcinomas arising in adenomas had a more favorable survival than adenocarcinomas not associated with adenomas. Logarithmic transformation of age-related incidence data demonstrates that cancers having differing histopathologic phenotypes represent a single population of tumors.
CONCLUSIONS: Prognostic factors include histologic type, grade, stage, and coexisting adenomas. These data should be included in pathology reports. Although certain histologic types exhibit morphologic differences, their pathogenesis appears to be similar.
Instituto Nacional de Ciencias Medicas y Nutricion, Salvador Zubiran, Mexico City, Mexico.
Descriptive study of gallbladder, extrahepatic bile duct, and ampullary cancers in the United States, 1997-2002.
Goodman MT, Yamamoto J
Cancer Causes Control. 2007;18(4):415.
OBJECTIVE: Few investigations of biliary tract (gallbladder, extrahepatic bile duct, ampulla of Vater) cancers have been conducted because of the relative rarity of these malignancies. The objective of this analysis was to compare the demographic, pathological, and clinical features of biliary tract cancers among men and women.
METHODS: Biliary tract cancers among 11,261 men and 15,722 women were identified through 33 US population-based registries during the period 1997-2002. These registries were estimated to represent 61% of the US population. Age-adjusted incidence rates (AAIR) were calculated per 100,000 population using counts derived from the 2000 US census.
RESULTS: The AAIR for gallbladder cancer among men (0.82 per 100,000) was significantly lower than the AAIR among women (1.45 per 100,000). By contrast, rates for extrahepatic bile duct and ampullary cancers were significantly higher among men (0.93 per 100,000 and 0.70 per 100,000, respectively) than among women (0.61 per 100,000 and 0.45 per 100,000, respectively). White men and women had significantly lower AAIRs for gallbladder cancer compared with other racial-ethnic groups, with the highest rates among Hispanics, American Indian-Alaska Natives, and Asian-Pacific Islanders. Asian-Pacific Islanders and Hispanics of both sexes had the highest AAIRs for extrahepatic bile duct and ampullary cancers. Ampullary tumors were more likely to be diagnosed at a localized or regional stage than were cancers of the gallbladder and extrahepatic bile duct. Asian-Pacific Islander men and women tended to have more unstaged cancers than other groups.
CONCLUSIONS: This population-based study suggests distinct etiologies of anatomic subsites of biliary tract cancer and caution against analytic investigations of all biliary tract cancers combined.
Epidemiology Program, University of Hawaii, Cancer Research Center Hawaii, 1236 Luahala Street, Honolulu, HI 96813, USA. firstname.lastname@example.org