An audit of outcomes of a series of periampullary carcinomas
Introduction
Overall, periampullary cancers account for 5% of all gastrointestinal tract malignancies,1 which can be divided into four groups of tumor entities: periampullary adenocarcinoma originates from the pancreatic duct (pancreatic carcinoma [PanCA]), the mucosa of the ampulla of Vater (ampullary carcinoma [AmpCA]), the common distal bile duct segment (distal cholangiocellular carcinoma [CholCA]) or the duodenum (duodenal adenocarcinoma [DuoCA]). PanCA occurs most frequently among the periampullary cancers, accounting for 3% of all gastrointestinal cancers. Carcinoma of the ampulla of Vateri is the second most common periampullary malignancy.2 Less frequent are distal cholangiocellular carcinoma and duodenal adenocarcinoma of the periampullary region.1
The prognosis of a 5-year survival rate between 1% and 10% for all periampullary cancers still remains a frustrating challenge.3 However, it has been shown that periampullary tumors, not arising from the pancreatic duct, have a much better outcome.2, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15 The reported series of periampullary carcinomas, excluding pancreatic carcinoma, usually involve relatively small numbers of patients and focus only on ampullary carcinoma.2, 4, 5, 7, 8, 9, 10, 13, 14
The aim of this study was to examine the results of resection and its impact on clinical outcomes on various types of carcinomas including AmpCA, CholCA and DuoCA. Moreover, prognostic factors, which predict survival, were also established.
Section snippets
Patients
Included in this study were 148 consecutive cases of non-pancreatic periampullary carcinomas, which during the final histological examination proved to be of ampullary, cholangial or duodenal origin. All patients underwent evaluation and treatment at the Department of Visceral and Transplantation Surgery at the University of Bern (11/1993–9/2001) and at the Department of General Surgery at the University of Heidelberg (10/2001–12/2005). All data were obtained from a prospective database and all
Results
Between November 1993 and December 2005, 78 AmpCA, 51 CholCA and 19 DuoCA were operated. The general characteristics and operations data of the three groups are shown in Table 1, Table 2, respectively.
Ampullary carcinoma
Several series of AmpCA reported significantly better long-term survival after resection in comparison to PanCA. Most of the 5-year survival rates for AmpCA were found between 32% and 39% in larger studies.2, 5, 8, 12, 13, 16 However, some reports presented even higher 5-year survival rates between 55% and 61%, 14, 17, 18, 19, 20 which is comparable to the survival showed in this study with 53.4%. In contrast, PanCA showed only a 5-year survival rate of 20%.21 The longer survival time may be
Conclusion
All three groups of non-pancreatic periampullary carcinomas show high resectability and an overall 92% curative resection rate in our present series. This is observed especially in AmpCA with a high 5-year survival rate of 51%. However, the extent of tumor invasion in the periampullary region is most critical as only T1/T2 tumors show a better prognosis than PanCA patients. Furthermore, absence of surgical complications determines long-term outcome. Thus, besides the radical approach,
Conflict of interest
All authors have no financial and personal relationships with other people or organizations that could inappropriately influence their work.
Statement of authorship
P.O. Berberat was involved in planning, conception and design of the study; writing of the manuscript; data collection; follow-up of patients; data evaluation; critical revision of the manuscript for important intellectual content. B.M. Künzli was involved in data collection, follow-up of patients, statistical analysis and testing, critical revision of the manuscript for important intellectual content. A. Gulbinas and T. Ramanauskas did the data evaluation, statistical analysis and testing. J.
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Cited by (63)
Molecular pathways in periampullary cancer: An overview
2022, Cellular SignallingCitation Excerpt :Periampullary adenocarcinoma (PAC) arises in the area surrounding Ampulla of Vater.It accounts for approximately 0.5–2% of all gastrointestinal malignancies and 20% of all tumors of the extrahepatic biliary tree [1–3](It includes tumors of heterogenous origin which are anatomically closely related and have a similar clinical presentation, itis anatomically categorized into tumors originating in the head of the pancreas (60%), the ampulla of Vater (20%), distal common bile duct (10%), and the duodenum (10%) [4].
Adjuvant therapy for periampullary carcinoma and the significance of histopathological typing: A systematic review
2022, Translational OncologyCitation Excerpt :Due to the similar anatomical position and different histological sources, there is a significant variation in the survival rate after resection [9]. The 5-year survival rates after surgical resection are 33–68% for ampullary carcinoma, 23–30% for distal common bile duct carcinoma, 25–59% for duodenal adenocarcinoma, and 5–20% for pancreatic carcinoma [8,16,18–22]. Metastatic or advanced PACs are characterized by worse prognosis with 2-year survival rates ranging from 5 to 10% [23].
Assessment of tumor heterogeneity: Differentiation of periampullary neoplasms based on CT whole-lesion histogram analysis
2019, European Journal of RadiologyCitation Excerpt :On the other hand, the gastrointestinal stromal tumor (GIST), the most common mesenchymal tumor of gastrointestinal tract, often occurs in small intestine and stomach, with rare occurrence in the duodenum [7,8]. In the periampullary region, PDAC, DAC and GIST make up approximately 3%, 0.4% and 2% of gastrointestinal malignancies respectively [7,9,10]. Previous studies showed that these two subtypes of adenocarcinomas and GIST differed in treatment planning and prognosis [7,11–13].
Clinical impact of ampulla of Vater cancer subtype classification based on immunohistochemical staining
2024, World Journal of Surgical Oncology
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Contributed equally to this study.