Medline ® Abstracts for References 4-6
Improved survival for adenocarcinoma of the ampulla of Vater: fifty-five consecutive resections.
Duffy JP, Hines OJ, Liu JH, Ko CY, Cortina G, Isacoff WH, Nguyen H, Leonardi M, Tompkins RK, Reber HA
Arch Surg. 2003;138(9):941.
HYPOTHESIS: After resection of an adenocarcinoma of the ampulla of Vater, certain clinical and pathologic characteristics influence long-term survival.
DESIGN: Retrospective case series.
SETTING: Major academic medical and pancreatic surgical center.
PATIENTS: Fifty-five consecutive patients who underwent Whipple resection for ampullary adenocarcinoma from 1988 through 2001.
INTERVENTIONS: Pylorus-preserving Whipple resection in 32 patients and standard Whipple resection in 23 patients.
MAIN OUTCOME MEASURES: Postoperative survival. A multivariate Cox proportional hazards model was used to determine the effects of various factors on long-term survival after resection.
RESULTS: There were no operative deaths, and all patients left the hospital. After a mean follow-up of 46.9 months, the overall 5-year Kaplan-Meier survival estimate was 67.7%. The median survival of the entire group has not yet been reached. Five-year postoperative survival estimates for node-negative (n = 32) and node-positive patients (n = 23) were 76.5% and 53.4%, respectively (P =.26). Patients whose tumors demonstrated perineural invasion (n = 12) had a 5-year survival estimate of 29.2% vs 78.8% for those whose did not (P<.001). On multivariate analysis, the absence of perineural invasion (P<.001) was an independent predictor of significantly improved postoperative survival.
CONCLUSIONS: Compared with previous reports from our own and other centers, this series demonstrates improved postoperative survival by 10% to 20% in patients undergoing Whipple resection for adenocarcinoma of the ampulla of Vater. The reasons for this improved outcome are unclear, and the effect of adjuvant treatment cannot be determined from this analysis. The major factor associated with prolonged survival was the absence of perineural invasion in the resected tumor specimen.
Section of Gastrointestinal Surgery, David Geffen School of Medicine, University of California-Los Angeles, 90095, USA.
Primary duodenal adenocarcinoma: a 40-year experience.
Ryder NM, Ko CY, Hines OJ, Gloor B, Reber HA
Arch Surg. 2000;135(9):1070.
HYPOTHESIS: In patients with duodenal adenocarcinoma, certain pathologic features of the tumor will have prognostic significance.
DESIGN: Retrospective case series.
PATIENTS: Forty-nine patients diagnosed with duodenal adenocarcinoma between 1957 and 1998.
RESULTS: The tumors of 31 (63%) of the 49 patients underwent resection, 18 (37%) had surgical palliation or underwent biopsy. Mean (+/- SEM) survival for all patients was 49 +/- 9 months. The patients whose tumors were resected had longer survival than those who underwent palliation (mean +/- SEM, 66 +/- 13 months vs 18 +/- 6 months, P =.02). Multivariate analysis revealed large tumor size (P =.01), transmural invasion (P =.004), and moderate to poor tumor grade (P =.03) were negatively correlated with survival. Lymph node status did not influence survival.
CONCLUSIONS: Our 40-year experience with duodenal adenocarcinoma demonstrates that large tumor size, advanced histological grade, and transmural invasion are associated with decreased survival. These results underscore the importance of early diagnosis, and suggest the presence of nodal spread is not a contraindication to resection.
UCLA School of Medicine, Division of General Surgery, PO Box 956904, 10833 Le Conte Ave, CHS 72-231, Los Angeles, CA 90095-6904, USA.
The Whipple operation: The classical surgical procedure to treat chronic pancreatitis
Ashley, SW, Reber, HA
Digestive Surgery. 1996; 13:113.