Carcinoma of the ampulla of Vater: results of surgical treatment of a single center

BACKGROUND/AIMS: The aim of this study was to retrospectively evaluate our experience with ampulla of Vater tumors at the Creighton University and to establish the role of curative pancreaticoduodenectomy on the long-term survival rate of patients. METHODOLOGY: Between 1975 and 1997, 21 patients (15 M, 6 F) with ampulla of Vater tumors were identified using our tumor registry database. The mean age at diagnosis was 74 years (range 45-85). Family history of other types of cancers was positive in 11 patients. The two most common presenting symptoms were painless jaundice (75%) and abdominal pain (31%). RESULTS: Thirteen patients (62%) underwent curative pancreaticoduodenectomy and eight patients (38%) underwent palliative biliary bypass procedures. Pathological staging of thirteen pancreaticoduodenectomy patients included stage I, 5 patients; stage II, 1 patient; stage III, 2 patients and stage IV, 5 patients. There were nine patients with NO disease and 4 patients with N1 disease. The Kaplan-Meier analysis revealed significant survival benefit for pancreaticoduodenectomy patients (69.9 months) compared to the palliative procedure (4.8 months). Furthermore NO patients had a far better survival (69.9 months) compared to N1 patients (5.9 months) although this difference was not significant. There were no operative mortalities. CONCLUSIONS: Radical surgery such as pancreaticoduodenectomy seems to confirm long-term survival in patients with ampulla of Vater tumors especially when no nodal or distant metastases are present at the time of surgery. An aggressive approach, therefore, in such patients is justifiable.