The authors declare that they have no competing interests.
JS, ZL and HL were the key authors for the conception, design, coordination, and drafting of the manuscript, as well as the analysis and interpretation of the data. CY, YS and CW participated in the design and interpretation of the data and helped in drafting the manuscript. YS and CW contributed substantively by revising the manuscript critically for intellectual content and participating in the interpretation of data and the revision of the manuscript. All authors read and approved the final manuscript.
Early ampullary cancers present with good prognosis. Pancreaticoduodenectomy (PD) has been standard treatment for ampullary cancers, but it remains high rate of postoperative complications. So there raises a discussion on the role of local ampullectomy for early ampullary cancers (mainly focusing on pT1).
89 patients with pT1 ampullary cancer who underwent surgical treatment between 1978 and 2010 were retrospectively studied.
Rate of postoperative complications, especially post-operative pancreatic fistula (P = 0.009), after PD was higher than after local ampullectomy, . Multivariate analysis showed that tumor size (HR 2.204; P = 0.014), lymph node metastasis (HR 4.362; P < 0.001), lymph vascular invasion (HR 4.258; P < 0.001), and perineural invasion (HR 4.467; P < 0.001), gross morphology (HR 2.536; P = 0.004) and tumor grade (HR 4.213; P = 0.001) were independent risk factors for long-term survival, as well as risk factors for failure of ampullectomy in early ampullary cancer. For patients absent of these factors, local ampullectomy would achieve a good prognosis.
Because of high rate of lymph node metastasis, PD should be preferably performed for radical resection. Local ampullectomy could be an alternative for patients in high operative risk; and would achieve a good outcome in patients whose tumors were well differentiated and showed polypoid gross morphology and size ≤1 cm.
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- Long-term prognosis of surgical treatment for early ampullary cancers and implications for local ampullectomy
- BioMed Central
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