壶腹肿瘤手术238例分析

目的 探讨壶腹肿瘤手术方式的合理选择.方法 回顾性分析北京协和医院1995年1月至2012年6月收治的238例壶腹肿瘤的临床病理资料.51例良性肿瘤患者中,行肿瘤局部切除术34例,胰十二指肠切除术17例;187例壶腹癌患者中,行壶腹局部切除术25例,胰十二指肠切除术162例.结果 无论是对于壶腹癌还是良性肿瘤,与胰十二指肠切除术相比,行局部切除术者手术时间更短、术中出血量更少、住院时间更短、术后并发症发生率更低(均P＜0.05).壶腹部良性肿瘤行局部切除术组与行胰十二指肠切除术组的术后生存时间差异无统计学意义(P=0.071,x2=2.003).T1、T2期壶腹癌两种术式组术后生存时间差异也无统计学意义(P=0.054,x2=3.163);但T3、T4期胰十二指肠切除术组术后生存时间明显长于局部切除术组(P=0.041,x2=6.309).结论 壶腹肿瘤对手术治疗的反应相对良好.对于良性肿瘤及T1～2期壶腹癌,局部切除可达到根治目的;而对于T3～4期壶腹癌,则应行胰十二指肠切除术.     

壶腹部周围癌94例临床分析

目的探讨壶腹部周围癌的诊断和治疗方法。方法回顾性分析我院2000年1月～2007年1月收治的壶腹部周围癌94例的临床资料。结果行胰十二指肠切除术者1、2、3、5年生存率分别为42．85％、28．75％、14．2％和9．52％;十二指肠肿瘤局部切除术者1、2、3年生存率分别为100％、50％和0;胆肠吻合、胃肠吻合手术者1年生存率为0。结论胰十二指肠切除术仍然是治疗壶腹部周围癌最有效的措施。对合并急性梗阻性胆管炎的病人建议二期手术治疗,可提高手术安全性。     

早期壶腹癌的局部切除治疗

目的 评估早期壶腹癌局部切除的可行性.方法 回顾性分析20年间共36例术后病理证实为Tl期(pTl)的壶腹癌,其中局部切除11例,胰十二指肠切除25例.对其术前和术中的诊断和分期进行评价,同时对不同手术方式的围手术期并发症及死亡率、住院时间、术后肿瘤复发及长期生存状况进行统计分析.结果 与胰十二指肠切除术相比,局部切除手术操作简单,围手术期并发症发生率低(P=0.031);但两组的术后住院时间(P=0.254)、围手术期死亡率(P=1.000)、术后无复发生存率(P=0.301)及长期生存率(P=0.289)之间相比差异均无统计学意义.结论 对于早期壶腹癌来说局部切除与胰十二指肠切除的治疗效果相当,且术后并发症发生率低,适用于手术风险较大或拒绝行胰十二指肠切除术的患者.     

胰头癌行胰十二指肠切除术诊治体会：附12例报告

探讨胰、十二指肠切除术在胰头癌治疗中的价值。方法　本组 12例胰头癌患者 ,男性 8例 ,女性 4例 ,通过B型超声、上腹部CT及ERCP术前检查 ,最后经手术和病理证实 ,均行胰十二指肠切除。结果　9例病愈出院 ,1例因胃肠道瘘仍住院 ,2例术后 2个月内死于病房 ,胰瘘发生率为 16 .6 7% (2 / 12 ) ,胆瘘发生率为16 .6 7% (2 / 12 ) ,肠梗阻 1例 ,无消化道出血及手术死亡率。结论　胰、十二指肠切除术是胰腺癌最有效的治疗方法 ,重视围手术期处理 ,能够降低并发症 ,提高切除率及生存率。     

乏特壶腹部癌局部切除的评价

目的探讨乏特壶腹部癌局部切除的可行性.方法对1988年5月至1999年5月间收治的32例乏特壶腹部癌进行回顾性分析,其中14例行局部切除术,18例行胰十二指肠切除术.结果局部切除术与胰十二指肠切除术两组比较术后并发症发生率分别为7%和39%,P<0.05.平均住院日分别为(10.1±2.3)d和(23.1±5.7)d.术后1年生存率分别为86%(12/14)和89%(16/18),P>0.05;5年生存率分别为30%(3/10)和62%(8/13),P<0.05.结论乏特壶腹部癌局部切除手术创伤相对小、术后并发症显著减少,对于全身状况较差者以及早期肿瘤可用局部切除术.     

壶腹部癌行胰十二指肠切除术的疗效及影响生存率的因素分析

在胰头区域的恶性肿瘤中,壶腹部癌的发生率相当高,仅次于胰腺癌。壶腹部癌切除效果远比胰腺癌好。尽管壶腹部癌术后有较满意的效果,但仍有50％以上的病人死于肿瘤复发。本文目的是通过评价死亡率、住院并发症、后期并发症及生存率来确定壶腹部癌行胰十二指肠切除术的效果,分析与生存率密切相关的预后因素以及找出有高危复发的病人。 1984年至1992年间,67例壶腹部癌症人行胰十二指肠切除术,男性42例,女性25例。平均年龄61岁(39～74岁)。自1987年开始,采用标准的影像学检查,包括常规超声波、CT、ERCP、腔内超声及选择性动脉造影检查。     

无黄疸期壶腹周围癌的诊治体会

目的 探讨无黄疸期壶腹周围癌的临床特征及诊治体会.方法 回顾性分析27例无黄疸表现的壶腹周围癌的临床资料.结果 27例患者中23例有长期上腹部隐痛不适,7例合并上腹部饱胀,5例为胆道术后T管不能拔除,2例合并胆管炎.肿瘤指标未超过正常值三倍.MRCP提示胆胰管扩张的有21例,ERCP提示肿瘤有22例.结论 壶腹周围癌早期无特异性症状,胆胰管扩张是其一个影像学特征,ERCP可提高早期诊断率,胰十二指肠切除术是其首选术式.     

十二指肠壶腹部神经内分泌癌的诊断与治疗(附七例报告)

目的 探讨十二指肠壶腹部神经内分泌癌临床病理学特征、诊断和治疗方法.方法 回顾分析7例十二指肠壶腹部神经内分泌癌病例并结合文献,综合分析十二指肠壶腹部神经内分泌癌的临床病理学特征、诊断及治疗.结果 7例十二指肠壶腹部神经内分泌癌占同期十二指肠壶腹部肿瘤的4.32%(7/162).主要临床症状为腹痛、梗阻性黄疸、消化道出血和贫血.术前影像学检查是诊断十二指肠壶腹部肿瘤的主要手段,其中1例患者在术前经内镜及内镜超声确诊.经组织病理及免疫组化诊断为大细胞神经内分泌癌3例、小细胞神经内分泌癌3例,不典型类癌1例.其中行胰十二指肠切除术5例,行十二指肠乳头部肿瘤局部切除术2例.所有患者均得到随访.全组中位生存期为23个月.结论 十二指肠壶腹部神经内分泌癌罕见.针对十二指肠壶腹部高级别神经内分泌癌进行根治性切除可能改善患者的预后.     

胰十二指肠切除在治疗85例壶腹周围癌的经验

目的 探讨对壶腹周围肿瘤施行胰十二指肠切除术的经验。方法 回顾性总结施行胰十二指肠切除术85例的临床资料,分析壶腹周围癌的早期诊断、手术方式,即标准胰十二指肠切除(SPD)保留幽门胰十二指肠切除(PPPD)和扩大胰十二指肠切除术(EPD)。全组病例消化道重建采用Child术式,空肠-胰腺端端套入法。结果 ①全组病例经病理确诊,其中胰头癌37例,乏特壶腹癌26例,胆管下段癌19例,十二指肠癌3例。胰周淋巴转移率为32.56％。②并发症:全组无术中死亡。术后并发上消化道出血3例(3.49％),肺部感染3例,胃排空障2例(2.33％),伤口、腹腔感染3例,术中大出血1例,胆瘘1例,多器官功能衰竭死亡1例。③生存率:全组病例获得随访,1、3、5年生存率分别为75.62％、34.64％、13.53％。结论 ①早期诊断是提高壶腹周围癌手术切除率和生存率的关键。强调对高危人群的检测、肿瘤标记物检查、早期B超、CT、螺旋CT三维成像等检查有助于早期诊断。②合理选择手术病例和方式,作者认为胰头癌原则上行PD,壶腹癌、胆管下段癌、十二指肠癌可考虑行PPPD,适当选择侵犯SMV-PV的病例施行EP手术是安全可行的。③预防胰瘘是降低PP病死率的关键。④做好围手术期处理是提高PP疗效的重要措施。     

扩大根治性与标准根治性胰十二指肠切除术的疗效比较

目的 探讨扩大根治性胰十二指肠切除术与标准根治性胰十二指肠切除术治疗胰头癌的疗效.方法 回顾性分析2001年至2011年四川大学华西医院收治的96例胰头癌患者的临床资料,根据患者的手术方式分为扩大组(行扩大根治性胰十二指肠切除术,41例)和标准组(行标准根治性胰十二指肠切除术,55例).观察并比较两组患者术中、术后和随访情况,并根据肿瘤患者生命质量评分标准对两组患者术后1年生命质量进行量化比较.所有计量资料采用秩和检验,计数资料采用方差分析,2个或多个样本率或构成比的比较采用x2检验.Kaplan-Meier法计算生存率,生存率比较采用Log-rank检验.结果 在两组患者年龄、肿瘤分化程度、肿瘤平均直径及淋巴结转移数目等基线情况无差异的情况下,扩大组患者的平均手术时间、术中平均出血量和术后平均住院时间分别为364 min(310～650 min)、680 ml (0～1800 ml)和13.5 d(10～76 d),明显高于标准组的315 min(260 ～306 min)、305 ml(0 ～ 1000 ml)和9.2d(7～30 d),两组比较,差异有统计学意义(F=7.15,4.22,3.82,P＜0.05).扩大组患者1级、2级和3a级并发症发生率分别为5％( 2/41)、20％(8/41)和41％( 17/41),而标准组患者分别为25％( 14/55)、49％(27/55)和7％ (4/55),两组比较,差异有统计学意义(x2 =5.76,8.87,14.10,P＜0.05).两组患者3b级、4a级并发症发生率比较,差异无统计学意义(x2=1.44,0.88,P＞0.05).两组患者的术后1、3、5年生存率,中位生存时间,术后1年生命质量评分及术后平均肿瘤复发时间比较,差异无统计学意义(x2 =0,0.13,0,F=0.49,1.03,t =0.32,P＞0.05).结论 标准根治性胰十二指肠切除术能够为普通胰头癌患者带来最佳的风险效率比,只有对于那些术前或术中发现有第16组淋巴结肿大且肿瘤能够达到R0切除的患者,才谨慎选择扩大根治性胰十二指肠切除术.     

联合血管切除重建的胰十二指肠切除术疗效分析

目的 探讨联合血管切除重建的胰十二指肠切除术的临床疗效.方法 回顾性分析2007年1月至2011年5月第三军医大学西南医院收治的56例术前诊断为胰腺肿瘤行联合血管切除重建的胰十二指肠切除术患者的临床资料,统计患者围手术期并发症发生率、病死率及术后生存情况.结果 本组患者平均手术时间为473 min(234～853 min),术中平均输血量为781 ml(0～900 ml),其中7例患者未输血;中位住院时间为25.9 d(17～100 d);43例患者进行了人工血管重建.56例患者围手术期并发症发生率为34％ (19/56),病死率为7％(4/56).术后病理诊断:胰头导管腺癌42例,壶腹部癌5例,胆管下端癌3例,十二指肠乳头癌4例,胰头神经内分泌癌1例,胰腺浆液性囊腺瘤1例.随访截至2011年8月,患者1年生存率为57％(32/56),平均生存时间为13.5个月.32例生存患者体质量均不同程度增加,无腹痛.术后3个月内5例患者有轻度腹泻,需要服用止泻药;1例患者术后1个月发现人造血管内血栓形成、中等量腹腔积液,半年后侧支循环形成,腹腔积液消失.结论 对于伴有血管侵犯的胰腺肿瘤患者,应积极行联合血管切除重建的胰十二指肠切除术,能改善胰腺癌晚期患者的生命质量.     

十二指肠乳头癌临床分析：附80例报告

目的:探讨十二指肠乳头癌早期诊断及手术方法。方法:回顾分析中南大学湘雅医院2010年3月—2017年3月收治的80例十二指肠乳头癌患者资料,其中16例行局部切除术,64例行胰十二指肠切除术。结果:主要首发临床表现为皮肤瘙痒、进行性黄疸60例(75.0%),腹痛不适40例(50.0%),畏寒、发热4例(5.0%),食欲不振、消瘦3例(3.75%),检查发现十二指肠乳头肿物2例(2.5%)。术前B超、CT、MRI、胃镜/十二指肠镜、ERCP阳性率分别为82.26%、89.66%、91.3%、93.75%、94.29%。行十二指肠乳头局部切除术16例中,13例为十二指肠乳头腺癌,1例为十二指肠乳头神经内分泌癌,2例为十二肠乳头腺瘤局部癌变;行胰十二指肠切除术组共64例中,61例为十二指肠乳头腺癌,2例为十二指肠乳头神经内分泌癌,1例为十二指肠乳头腺瘤局部癌变。与十二指肠切除术患者比较,局部切除术患者术中出血量、住院费用、术后并发症发生率均明显降低(均P0.05),但平均住院时间无统计学差异(P0.05),术后1、3、5年生存率均无统计学差异(均P0.05)。结论:对于十二指肠乳头癌,十二指肠镜及ERCP是相对较可靠的诊断方法,应首选胰十二指肠切除术;对于某些特殊病例,局部切除术在严格掌握其适应证的前提下,术中确保切缘阴性,可以作为一种安全有效的手术方式。     

Clinicopathologic analysis of early ampullary cancers with a focus on the feasibility of ampullectomy

OBJECTIVE: The purpose of this study was to evaluate whether ampullectomy can substitute for pancreatoduodenectomy (PD) in early ampullary cancer by clinicopathologic study. SUMMARY BACKGROUND DATA: Although ampullectomy has been attempted in early ampullary cancer (pTis, pT1), the indication and extent of resection have not been established. METHODS: Of 201 patients who had undergone PD for ampullary cancer between 1986 and 2002, 67 patients with a histologic diagnosis of pTis (n = 5) or pT1 (n = 62) cancer were analyzed retrospectively. Pathologic PD specimens were reviewed to analyze the cancer spread pattern, and medical records were reviewed for clinical outcomes. RESULTS: The 5-year survival rate of the 66 patients with early ampullary cancer (excluding one mortality) was 83.7%. Recurrence was confirmed in 12 patients (18.2%) and all died because of the recurrence. Pathologic review showed that 22 patients (32.8%) had at least one risk factor for failure after ampullectomy: lymph node metastasis (n = 6, 9.0%), perineural invasion (n = 1), or mucosal tumor infiltration along the CBD or P-duct (n = 15, 22.4%). Mean lengths of invasion into the CBD or the P-duct beyond the sphincter of Oddi were 7.7 mm (range, 1-25 mm) or 6.3 mm (range, 2-18 mm), respectively. Moreover, these risk factors were not correlated with tumor size, histologic grade, or the gross morphology of the primary tumor, although pTis cancer or pT1 cancer sized 1.0 cm or less was found to be least associated with risk factors. CONCLUSIONS: Ampullectomy for early ampullary cancer should not be considered an alternative operation to PD because of the high possibility of recurrence. PD should be preferably performed for adequate radical resection, even in early ampullary cancer, and ampullectomy should be reserved for those who have pTis or pT1 cancer sized 1.0 cm or less with high operative risk.     

低位直肠癌的局部切除结果及预后因素分析

目的 总结低位直肠癌局部切除的结果,分析影响预后的因素,探讨提高低位直肠癌局部切除疗效的方法.方法 回顾性分析1985年2月至2007年10月收治的76例低位直肠癌局部切除患者的临床病理资料.结果 76例患者中采用经肛切除69例,经骶切除6例,经阴道切除1例.肿瘤分期其中T1期48例,T2期25例,T3期3例.手术并发症发生率为7.9%,无手术死亡.局部复发率为22.4%,5年总体生存率84.5%.单因素分析提示肿瘤复发与肿瘤的T分期、切缘阳性显著相关,多因素分析显示T分期和切缘距离是与局部复发相关的独立影响因素.生存分析显示黏液腺癌、切缘阳性、血管淋巴管浸润显著影响术后的长期生存,而切缘阳性和血管淋巴管浸润是影响术后长期生存的独立预后因素.结论 局部切除安全性高,合理选择病例是低位直肠癌治愈性局部切除成功的关键.低位直肠癌局部切除的适应证为无高危因素(分化差、血管淋巴管侵犯、黏液腺癌)的T1-2,NO期患者;12期术后应行放化疗.     

混合入路在腹腔镜左半结肠癌根治术中的应用价值

目的:探讨混合入路在腹腔镜左半结肠癌根治术中的应用价值。方法:采用回顾性描述性研究方法。收集2015年1月至2018年3月河南省人民医院收治的96例左半结肠癌患者的临床病理资料;男52例,女44例;平均年龄为61岁,年龄范围为29~75岁。患者均施行腹腔镜左半结肠癌根治术。观察指标:(1)手术和术后恢复情况。(2)术后病理学检查情况。(3)术后化疗情况。(4)随访情况。采用门诊及电话方式进行随访,了解患者术后生存、肿瘤复发和转移情况。随访时间截至2019年10月。偏态分布的计量资料以M(范围)表示,计数资料以绝对数表示。结果:(1)手术和术后恢复情况:96例患者均采用混合入路施行腹腔镜左半结肠癌根治术。96例患者中,5例行腹腔镜联合多器官切除术(2例联合脾切除术、2例联合胃壁楔形切除术、1例联合脾脏和胰体尾切除术);7例行手助腹腔镜手术(5例因肿瘤侵犯需行多器官切除术、2例因近端肠管梗阻严重无法暴露加行回肠末端造瘘术);84例行腹腔镜辅助手术;无中转开腹。96例患者中,3例行回肠后方吻合,2例行旋转升结肠吻合,91例行原位吻合。96例患者手术时间为140 min(70~250 min),术中出血量为50 mL(30~140 mL);术后首次肛门排气时间为2 d(1~4 d)。96例患者中,术后5例切口感染,5例肺部感染,3例粘连性肠梗阻,1例吻合口瘘,均经保守治疗治愈。96例患者术后住院时间为8 d(5~27 d)。(2)术后病理学检查情况:96例患者清扫淋巴结数目为19枚(13~25枚);手术切除标本长度为35 cm(25~50 cm),切缘均为阴性。96例患者病理学T分期:pT1期5例,pT2期46例,pT3期37例,pT4期8例;病理学N分期:pN0期32例,pN1期47例,pN2期17例。96例患者均为M0期,无远处转移。96例患者病理学类型:黏液腺癌7例,低分化腺癌16例,中分化腺癌46例,高分化腺癌27例。(3)术后化疗情况:96例患者中,68例术后行奥沙利铂+卡培他滨方案规范化疗,28例术后未行化疗。(4)随访情况:96例患者中,86例获得随访,随访时间为19~58个月,中位随访时间为11个月。随访期间,86例患者均生存,其中82例未发现肿瘤复发;3例复查发现肝脏转移,带瘤生存;1例发现肝、肺转移,带瘤生存。结论:混合入路在腹腔镜左半结肠癌根治术中安全、可行。     

Histological factors contributing to a high risk of recurrence of submucosal invasive cancer (pT1) of the colon and rectum after endoscopic therapy

We analyzed the histological high-risk factors for recurrence of submucosal invasive carcinomas (pT1) of the colon and rectum after endoscopic therapy, examining pT1 cancers treated primarily by endoscopic resection within a 23-year period. We compared recurrent and nonrecurrent cancers, evaluating the following "highrisk factors" of the primary lesion: massive invasion, a surgical margin <2 mm but negativity for cancer in the cut end, poorly differentiated adenocarcinoma (PD) (G3), undifferentiated carcinoma (G4), and/or positive angiolymphatic invasion. The following histological factors were defined as predictive of a low risk: minimum invasion, a surgical margin >2 mm, well or moderately differentiated adenocarcinoma (G1, G2), and no evidence of angiolymphatic invasion. We analyzed the records of 37 patients with pT1 cancers, including 15 with high-risk factors who underwent subsequent resection. Local recurrence with or without liver metastases developed in 4 of these 15 patients. The histological type was PD in three (75%) of the four recurrent lesions. All four (100%) lesions showed a desmoplastic response (DR). Only 1 (9%) of the 11 patients without recurrence after subsequent surgery had a lesion with a small component of PD, and only three (27%) lesions showed a mild DR. We concluded that endoscopic therapy is inadequate for pT1 cancers with a histological PD component, and/or a DR in the cancer stroma.     

局部切除术治疗十二指肠乳头肿瘤

目的　探讨十二指肠乳头肿瘤的诊断及采取局切除的可行性及合理性。方法　回顾性分析近 9年来行局部切除治疗的 12例十二指肠乳头肿瘤患者临床资料。结果　 10 0 %以黄疸为主要症状 ,常伴有上腹隐痛不适。术前十二指肠镜活检对十二指肠乳头肿瘤的阳性诊断符合率为 75 .0 %。全无手术死亡。 83 .3 %的病例获随访 1～ 5年 ,良性肿瘤 5例术后均恢复原工作 ,T1 期高分化腺癌 4例术后存活至今 ,分别达 62 ,3 1,84,3 6个月。结论　十二指肠乳头肿瘤局部切除术对于良性乳头肿瘤及T1 期高分化腺癌 ,是一种安全、有效、合理术式的选择 ,但术中严格要求完整切除 ,边缘无瘤残留。     

Pancreaticoduodenectomy with vascular resection: margin status and survival duration

Major vascular resection performed at the time of pancreaticoduodenectomy (PD) for adenocarcinoma remains controversial. We analyzed all patients who underwent vascular resection (VR) at the time of PD for any histology at a single institution between 1990 and 2002. Preoperative imaging criteria for PD included the absence of tumor extension to the celiac axis or superior mesenteric artery (SMA). Tangential or segmental resection of the superior mesenteric or portal veins was performed when the tumor could not be separated from the vein. As a separate analysis, all patients who underwent PD with VR for pancreatic adenocarcinoma were compared to all patients who underwent standard PD for pancreatic adenocarcinoma. A total of 141 patients underwent VR with PD. Superior mesenteric-portal vein resections included tangential resection with vein patch (n = 36), segmental resection with primary anastomosis (n = 35), and segmental resection with autologous interposition graft (n = 55). Hepatic arterial resections were performed in 10 patients, and resections of the anterior surface of the inferior vena cava were performed in 5 patients. PD was performed for pancreatic adenocarcinoma in 291 patients; standard PD was performed in 181 and VR in 110. Median survival was 23.4 months in the group that required VR and 26.5 months in the group that underwent standard PD (P = 0.177). A Cox proportional hazards model was constructed to analyze the effects of potential prognostic factors (VR, tumor size, T stage, N status, margin status) on survival. The need for VR had no impact on survival duration. In conclusion, properly selected patients with adenocarcinoma of the pancreatic head who require VR have a median survival of approximately 2 years, which does not differ from those who undergo standard PD and is superior to historical patients believed to have locally advanced disease treated nonoperatively. Presented at the Forty-Fifth Annual Meeting of The Society for Surgery of the Alimentary Tract, New Orleans, Louisiana, May 15–19, 2004 Presented at the Forty-Fifth Annual Meeting of The Society for Surgery of the Alimentary Tract, New Orleans, Louisiana, May 15–19, 2004 Supported by the Lockton Fund for Pancreatic Cancer Research, The University of Texas M. D. Anderson Cancer Center.     

Tumors of the ampulla of vater: histopathologic classification and predictors of survival

BACKGROUND: The histology and clinical behavior of ampullary tumors vary substantially. We speculated that this might reflect the presence of two kinds of ampullary adenocarcinoma: pancreaticobiliary and intestinal. STUDY DESIGN: We analyzed patient demographics, presentation, survival (mean followup 44 months), and tumor histology for 157 consecutive ampullary tumors resected from 1989 to 2006. Histologic features were reviewed by a pathologist blinded to clinical outcomes. Survival was compared using Kaplan-Meier/Cox proportional hazards analysis. RESULTS: There were 33 benign (32 adenomas and 1 paraganglioma) and 124 malignant (118 adenocarcinomas and 6 neuroendocrine) tumors. One hundred fifteen (73%) patients underwent a Whipple procedure, 32 (20%) a local resection, and 10 (7%) a palliative operation. For adenocarcinomas, survival in univariate models was affected by jaundice, histologic grade, lymphovascular, or perineural invasion, T stage, nodal metastasis, and pancreaticobiliary subtype (p < 0.05). Size of tumor did not predict survival, nor did cribriform/papillary features, dirty necrosis, apical mucin, or nuclear atypia. In multivariate models, lymphovascular invasion, perineural invasion, stage, and pancreaticobiliary subtype predicted survival (p < 0.05). Patients with pancreaticobiliary ampullary adenocarcinomas presented with jaundice more often than those with the intestinal kind (p = 0.01) and had worse survival. CONCLUSIONS: In addition to other factors, tumor type (intestinal versus pancreaticobiliary) had a major effect on survival in patients with ampullary adenocarcinoma. The current concept of ampullary adenocarcinoma as a unique entity, distinct from duodenal and pancreatic adenocarcinoma, might be wrong. Intestinal ampullary adenocarcinomas behaved like their duodenal counterparts, but pancreaticobiliary ones were more aggressive and behaved like pancreatic adenocarcinomas.