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

الملخص EN

Introduction.

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.

Methods.

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%).

Results.

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 P=0.001, lymphatic vessel invasion P=0.0001, intraoperative administration of packed red blood cells P=0.03, an elevated CA 19-9 P=0.03, jaundice P=0.04, and an impaired patient condition P=0.01 are strong negative predictors for a reduced patient survival.

Conclusions.

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.