Adenocarcinoma of the ampulla of Vater

A 28-year experience

Mark A. Talamini, Robert C. Moesinger, Henry A. Pitt, Taylor A. Sohn, Ralph H. Hruban, Keith D. Lillemoe, Charles J. Yeo, John L. Cameron

Research output: Contribution to journalArticle

252 Citations (Scopus)

Abstract

Objective: The aims of this study were to review the experience with adenocarcinoma of the ampulla of Vater at The Johns Hopkins Hospital and to determine what factors influenced the long-term outcome in these patients. Summary Background Data: Adenocarcinoma of the ampulla of Vater is the second most common periampullary malignancy. However, most series have relatively small numbers. As a result, analysis of factors influencing outcome has been limited. Methods: From 1969 to 1996, 120 patients with adenocarcinoma of the ampulla of Vater were managed at The Johns Hopkins Hospital. Clinical, operative, and pathologic factors were correlated with morbidity and long- term survival. Factors influencing outcome were evaluated by univariate and multivariate analyses. Results: Resection was performed in 106 patients (88%), and 105 of these patients (99%) underwent either pancreatoduodenal resection (n = 103) or total pancreatectomy (n = 2). Resection rate increased from 62% in the 1970s to 82% in the 1980s to 96% in the 1990s (p < 0.05). Overall mortality after resection was 3.8% with no mortality in the 45 consecutive patients resected in the past 5 years. Morbidity also decreased significantly (p < 0.05) from 70% before to 38% after December 1992. Five- year survival for resected patients was 38%. Factors favorably influencing long-term outcome were resection (p < 0.001), no perioperative blood transfusions (p < 0.05), negative lymph node status (p = 0.05), and moderate or well-differentiated tumors (p < 0.05). In a multivariate analysis, the best predictor of prolonged survival was absence of intraoperative transfusion (p = 0.06, relative risk = 1.90, 95% confidence limits = 0.95- 3.78). Conclusions: Compared to carcinoma of the pancreas, carcinoma of the ampulla of Vater has a higher resectability rate and a better prognosis. Early diagnosis is important because lymph node status influences survival. Careful operative dissection and avoidance of transfusions also improves long-term survival.

Original languageEnglish (US)
Pages (from-to)590-600
Number of pages11
JournalAnnals of Surgery
Volume225
Issue number5
DOIs
StatePublished - 1997
Externally publishedYes

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Ampulla of Vater
Adenocarcinoma
Survival
Multivariate Analysis
Lymph Nodes
Morbidity
Carcinoma
Pancreatectomy
Mortality
Blood Transfusion
Statistical Factor Analysis
Dissection
Early Diagnosis
Pancreas
Neoplasms

ASJC Scopus subject areas

  • Surgery

Cite this

Talamini, M. A., Moesinger, R. C., Pitt, H. A., Sohn, T. A., Hruban, R. H., Lillemoe, K. D., ... Cameron, J. L. (1997). Adenocarcinoma of the ampulla of Vater: A 28-year experience. Annals of Surgery, 225(5), 590-600. https://doi.org/10.1097/00000658-199705000-00015

Adenocarcinoma of the ampulla of Vater : A 28-year experience. / Talamini, Mark A.; Moesinger, Robert C.; Pitt, Henry A.; Sohn, Taylor A.; Hruban, Ralph H.; Lillemoe, Keith D.; Yeo, Charles J.; Cameron, John L.

In: Annals of Surgery, Vol. 225, No. 5, 1997, p. 590-600.

Research output: Contribution to journalArticle

Talamini, MA, Moesinger, RC, Pitt, HA, Sohn, TA, Hruban, RH, Lillemoe, KD, Yeo, CJ & Cameron, JL 1997, 'Adenocarcinoma of the ampulla of Vater: A 28-year experience', Annals of Surgery, vol. 225, no. 5, pp. 590-600. https://doi.org/10.1097/00000658-199705000-00015
Talamini MA, Moesinger RC, Pitt HA, Sohn TA, Hruban RH, Lillemoe KD et al. Adenocarcinoma of the ampulla of Vater: A 28-year experience. Annals of Surgery. 1997;225(5):590-600. https://doi.org/10.1097/00000658-199705000-00015
Talamini, Mark A. ; Moesinger, Robert C. ; Pitt, Henry A. ; Sohn, Taylor A. ; Hruban, Ralph H. ; Lillemoe, Keith D. ; Yeo, Charles J. ; Cameron, John L. / Adenocarcinoma of the ampulla of Vater : A 28-year experience. In: Annals of Surgery. 1997 ; Vol. 225, No. 5. pp. 590-600.
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abstract = "Objective: The aims of this study were to review the experience with adenocarcinoma of the ampulla of Vater at The Johns Hopkins Hospital and to determine what factors influenced the long-term outcome in these patients. Summary Background Data: Adenocarcinoma of the ampulla of Vater is the second most common periampullary malignancy. However, most series have relatively small numbers. As a result, analysis of factors influencing outcome has been limited. Methods: From 1969 to 1996, 120 patients with adenocarcinoma of the ampulla of Vater were managed at The Johns Hopkins Hospital. Clinical, operative, and pathologic factors were correlated with morbidity and long- term survival. Factors influencing outcome were evaluated by univariate and multivariate analyses. Results: Resection was performed in 106 patients (88{\%}), and 105 of these patients (99{\%}) underwent either pancreatoduodenal resection (n = 103) or total pancreatectomy (n = 2). Resection rate increased from 62{\%} in the 1970s to 82{\%} in the 1980s to 96{\%} in the 1990s (p < 0.05). Overall mortality after resection was 3.8{\%} with no mortality in the 45 consecutive patients resected in the past 5 years. Morbidity also decreased significantly (p < 0.05) from 70{\%} before to 38{\%} after December 1992. Five- year survival for resected patients was 38{\%}. Factors favorably influencing long-term outcome were resection (p < 0.001), no perioperative blood transfusions (p < 0.05), negative lymph node status (p = 0.05), and moderate or well-differentiated tumors (p < 0.05). In a multivariate analysis, the best predictor of prolonged survival was absence of intraoperative transfusion (p = 0.06, relative risk = 1.90, 95{\%} confidence limits = 0.95- 3.78). Conclusions: Compared to carcinoma of the pancreas, carcinoma of the ampulla of Vater has a higher resectability rate and a better prognosis. Early diagnosis is important because lymph node status influences survival. Careful operative dissection and avoidance of transfusions also improves long-term survival.",
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T1 - Adenocarcinoma of the ampulla of Vater

T2 - A 28-year experience

AU - Talamini, Mark A.

AU - Moesinger, Robert C.

AU - Pitt, Henry A.

AU - Sohn, Taylor A.

AU - Hruban, Ralph H.

AU - Lillemoe, Keith D.

AU - Yeo, Charles J.

AU - Cameron, John L.

PY - 1997

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N2 - Objective: The aims of this study were to review the experience with adenocarcinoma of the ampulla of Vater at The Johns Hopkins Hospital and to determine what factors influenced the long-term outcome in these patients. Summary Background Data: Adenocarcinoma of the ampulla of Vater is the second most common periampullary malignancy. However, most series have relatively small numbers. As a result, analysis of factors influencing outcome has been limited. Methods: From 1969 to 1996, 120 patients with adenocarcinoma of the ampulla of Vater were managed at The Johns Hopkins Hospital. Clinical, operative, and pathologic factors were correlated with morbidity and long- term survival. Factors influencing outcome were evaluated by univariate and multivariate analyses. Results: Resection was performed in 106 patients (88%), and 105 of these patients (99%) underwent either pancreatoduodenal resection (n = 103) or total pancreatectomy (n = 2). Resection rate increased from 62% in the 1970s to 82% in the 1980s to 96% in the 1990s (p < 0.05). Overall mortality after resection was 3.8% with no mortality in the 45 consecutive patients resected in the past 5 years. Morbidity also decreased significantly (p < 0.05) from 70% before to 38% after December 1992. Five- year survival for resected patients was 38%. Factors favorably influencing long-term outcome were resection (p < 0.001), no perioperative blood transfusions (p < 0.05), negative lymph node status (p = 0.05), and moderate or well-differentiated tumors (p < 0.05). In a multivariate analysis, the best predictor of prolonged survival was absence of intraoperative transfusion (p = 0.06, relative risk = 1.90, 95% confidence limits = 0.95- 3.78). Conclusions: Compared to carcinoma of the pancreas, carcinoma of the ampulla of Vater has a higher resectability rate and a better prognosis. Early diagnosis is important because lymph node status influences survival. Careful operative dissection and avoidance of transfusions also improves long-term survival.

AB - Objective: The aims of this study were to review the experience with adenocarcinoma of the ampulla of Vater at The Johns Hopkins Hospital and to determine what factors influenced the long-term outcome in these patients. Summary Background Data: Adenocarcinoma of the ampulla of Vater is the second most common periampullary malignancy. However, most series have relatively small numbers. As a result, analysis of factors influencing outcome has been limited. Methods: From 1969 to 1996, 120 patients with adenocarcinoma of the ampulla of Vater were managed at The Johns Hopkins Hospital. Clinical, operative, and pathologic factors were correlated with morbidity and long- term survival. Factors influencing outcome were evaluated by univariate and multivariate analyses. Results: Resection was performed in 106 patients (88%), and 105 of these patients (99%) underwent either pancreatoduodenal resection (n = 103) or total pancreatectomy (n = 2). Resection rate increased from 62% in the 1970s to 82% in the 1980s to 96% in the 1990s (p < 0.05). Overall mortality after resection was 3.8% with no mortality in the 45 consecutive patients resected in the past 5 years. Morbidity also decreased significantly (p < 0.05) from 70% before to 38% after December 1992. Five- year survival for resected patients was 38%. Factors favorably influencing long-term outcome were resection (p < 0.001), no perioperative blood transfusions (p < 0.05), negative lymph node status (p = 0.05), and moderate or well-differentiated tumors (p < 0.05). In a multivariate analysis, the best predictor of prolonged survival was absence of intraoperative transfusion (p = 0.06, relative risk = 1.90, 95% confidence limits = 0.95- 3.78). Conclusions: Compared to carcinoma of the pancreas, carcinoma of the ampulla of Vater has a higher resectability rate and a better prognosis. Early diagnosis is important because lymph node status influences survival. Careful operative dissection and avoidance of transfusions also improves long-term survival.

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