Journal of the Formosan Medical Association
Volume 106, Issue 6 , Pages 432-443, 2007

Predictors of Recurrence After Pancreaticoduodenectomy in Ampullary Cancer: Comparison Between Non-, Early and Late Recurrence

  • Hui-Ping Hsu

      Affiliations

    • Division of General Surgery, Department of Surgery, National Cheng Kung University Hospital
    • Institute of Clinical Medicine, College of Medicine, National Cheng Kung University
    • ,
  • Yan-Shen Shan

      Affiliations

    • Division of General Surgery, Department of Surgery, National Cheng Kung University Hospital
    • Corresponding Author InformationCorrespondence to: Dr Yan-Shen Shan, Division of General Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138 Sheng-Li Road, Tainan 70428, Taiwan
    • ,
  • Yu-Hsiang Hsieh

      Affiliations

    • Department of Emergency Medicine, The Johns Hopkins University School of Medicine, Baltimore, USA
    • ,
  • Ta-Ming Yang

      Affiliations

    • Department of Surgery, Tainan Municipal Hospital, Tainan, Taiwan
    • ,
  • Pin-Wen Lin

      Affiliations

    • Division of General Surgery, Department of Surgery, National Cheng Kung University Hospital

Received 29 August 2006; received in revised form 5 December 2006; accepted 6 February 2007.

Article Outline

Background/purpose

Ampullary cancer is one of the periampullary cancers with a better prognosis, but relapse still occurs early in some patients. We sought to find predictors of recurrence to facilitate decisions about postoperative therapy.

Methods

Between January 1989 and March 2006, information was gathered on a total of 127 patients undergoing pancreaticoduodenectomy with regional lymphadenectomy for ampullary cancer at National Cheng Kung University Hospital and Tainan Municipal Hospital. Clinical information, histopathologic results and long-term outcomes were collected and predictors for recurrence were identified.

Results

Fifty-eight patients (46%) survived without evidence of recurrence (non-recurrence), while 32 patients (25%) suffered recurrent disease after 12 months (late recurrence) and 37 patients (29%) developed recurrent disease within 12 months (early recurrence). The median follow-up for non-recurrence was 65 months, 13 months for early recurrence, and 36 months for late recurrence. Patterns of recurrence were similar, without any significant difference between the early recurrence and late recurrence groups. The early and late recurrence patients had higher levels of microscopically (R1) or macroscopically (R2) positive margin of resection and more advanced disease (advanced tumor stage, numbers of lymph nodes involved, lymph node status, pancreatic invasion and TNM stage) than the non-recurrence group. After multivariate analysis, positive resection margin, pancreatic invasion and lymph node involvement were significant predictors for disease recurrence. Lymph node involvement was the main differentiating predictor between the late and early recurrence groups (odds ratio, 1.982; 95% confidence interval, 1.101-3.567; p = 0.022).

Conclusion

Positive resection margin, pancreatic invasion, and lymph node involvement were found to be predictors for disease recurrence and indicators for postoperative treatment.

Key Words:  adenocarcinoma , ampulla of Vater , predictors of recurrence

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PII: S0929-6646(09)60292-8

doi:10.1016/S0929-6646(09)60292-8

Journal of the Formosan Medical Association
Volume 106, Issue 6 , Pages 432-443, 2007

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