Medline ® Abstracts for References 7-9
of 'Ampullary carcinoma: Epidemiology, clinical manifestations, diagnosis and staging'
The use of endoscopic ultrasonography to reduce the cost of treating ampullary tumors.
Quirk DM, Rattner DW, Fernandez-del Castillo C, Warshaw AL, Brugge WR
Gastrointest Endosc. 1997;46(4):334.
BACKGROUND: Local excision of selected ampullary tumors may result in the same benefit as Whipple resection with less morbidity and mortality. The purpose of this study was to determine if endoscopic ultrasonography could aid in the selection of patients for local resection and to determine if there was a significant cost difference between the two surgical procedures.
METHODS: In this retrospective study of 32 patients who underwent surgery for ampullary tumors, endoscopic ultrasonography staging was performed in 18 patients. Resected specimens were used to determine pathologic staging. Local disease was defined as stage T2N0 or less. Cost data were available for 20 patients.
RESULTS: The sensitivity and specificity of endoscopic ultrasonography for differentiating local from advanced ampullary tumors were both 83%. The median total cost for a local resection was $9314 versus $16,017 for a Whipple resection (p<0.0017).
CONCLUSION: Endoscopic ultrasonography is an effective tool for identifying patients with localized ampullary tumors. The cost of a local resection for ampullary tumors is significantly less than that of a Whipple resection. The use of endoscopic ultrasonography to select patients for local resection may be a cost-effective technique in the management of patients with ampullary tumors.
Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston 02114, USA.
Adenocarcinoma of the ampulla of Vater. A 28-year experience.
Talamini MA, Moesinger RC, Pitt HA, Sohn TA, Hruban RH, Lillemoe KD, Yeo CJ, Cameron JL
Ann Surg. 1997;225(5):590.
OBJECTIVE: The aim of this study were to review the experience with adenocarcinoma of the ampulla of Vater at The Johns Hopkins Hospital and to determine what factors influenced the long-term outcome in these patients.
SUMMARY BACKGROUND DATA: Adenocarcinoma of the ampulla of Vater is the second most common periampullary malignancy. However, most series have relatively small numbers. As a result, analysis of factors influencing outcome has been limited.
METHODS: From 1969 to 1996, 120 patients with adenocarcinoma of the ampulla of Vater were managed at The Johns Hopkins Hospital. Clinical, operative, and pathologic factors were correlated with morbidity and long-term survival. Factors influencing outcome were evaluated by univariate and multivariate analyses.
RESULTS: Resection was performed in 106 patients (88%), and 105 of these patients (99%) underwent either pancreatoduodenal resection (n = 103) or total pancreatectomy (n = 2). Resection rate increased from 62% in the 1970s to 82% in the 1980s to96% in the 1990s (p<0.05). Overall mortality after resection was 3.8% with no mortality in the 45 consecutive patients resected in the past 5 years. Morbidity also decreased significantly (p<0.05) from 70% before to 38% after December 1992. Five-year survival for resected patient was 38%. Factors favorably influencing long-term outcome were resection (p<0.001), no perioperative blood transfusions (p<0.05), negative lymph node status (p = 0.05), and moderate or well-differentiated tumors (p<0.05). In a multivariate analysis, the best predictor of prolonged survival was absence of intraoperative transfusion (p = 0.06, relative risk = 1.90, 95% confidence limits = 0.95-3.78).
CONCLUSIONS: Compared to carcinoma of the pancreas, carcinoma of the ampulla of Vater has a higher resectability rate and a better prognosis. Early diagnosis is important because lymph node status influences survival. Careful operative dissection and avoidance of transfusions also improves long-term survival.
Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
Upper gastrointestinal cancer in familial polyposis
Jagelman DG, DeCosse JJ, Bussey HJ