The role of local excision in invasive adenocarcinoma of the ampulla of vater

Jim Zhong, Manisha Palta, Christopher G. Willett, Shannon J. McCall, Anuradha Bulusu, Douglas Tyler, Rebekah R. White, Hope E. Uronis, Theodore N. Pappas, Brian G. Czito

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Background: Ampulla of Vater carcinomas are rare malignancies that have been traditionally treated with radical surgical resection. Given the mortality associated with pancreaticoduodenectomy, some patients may benefit from local resection. A single-institution outcomes analysis was performed to define the role of local resection. Methods: Patients undergoing local resection (ampullectomy) for ampullary carcinomas at Duke University between 1976 and 2010 were analyzed retrospectively. Time-to-event analysis was conducted analyzing all patients undergoing surgery, with and without adjuvant chemoradiation therapy (CRT). Overall survival (OS), local control (LC), metastases-free survival (MFS), and disease-free survival (DFS) were studied using Kaplan-Meier analysis. Results: A total of 17 patients with invasive carcinoma underwent ampullectomy. The 3-and 5-year LC, MFS, DFS and OS rates were 36% and 24%, 68% and 54%, 31% and 21%, and 35% and 21%, respectively. Patients receiving adjuvant CRT did not appear to have improved outcomes compared with surgery alone, although this group tended to have poorer histological grade, more advanced tumor staging and involved surgical margins. Conclusions: Ampullectomy for invasive ampullary adenocarcinomas is a safe procedure but does not offer satisfactory long-term results, mostly due to high local failure rates. Adjuvant CRT therapy does not appear to offer increased local control or survival benefit following ampullectomy, although these results may suffer from selection bias and small sample size. Local resection should be limited to benign ampullary lesions or patients with very small, early tumors with favorable histologic features where radical resection is not feasible.

Original languageEnglish (US)
Pages (from-to)8-13
Number of pages6
JournalJournal of Gastrointestinal Oncology
Volume4
Issue number1
DOIs
StatePublished - 2013
Externally publishedYes

Fingerprint

Ampulla of Vater
Adenocarcinoma
Carcinoma
Disease-Free Survival
Neoplasm Metastasis
Pancreaticoduodenectomy
Survival
Selection Bias
Neoplasm Staging
Kaplan-Meier Estimate
Therapeutics
Sample Size
Neoplasms
Survival Rate
Mortality

Keywords

  • Ampulla of vater
  • Ampullary resection
  • Ampullectomy
  • Local resection
  • Pancreaticoduodenectomy

ASJC Scopus subject areas

  • Oncology
  • Gastroenterology

Cite this

The role of local excision in invasive adenocarcinoma of the ampulla of vater. / Zhong, Jim; Palta, Manisha; Willett, Christopher G.; McCall, Shannon J.; Bulusu, Anuradha; Tyler, Douglas; White, Rebekah R.; Uronis, Hope E.; Pappas, Theodore N.; Czito, Brian G.

In: Journal of Gastrointestinal Oncology, Vol. 4, No. 1, 2013, p. 8-13.

Research output: Contribution to journalArticle

Zhong, J, Palta, M, Willett, CG, McCall, SJ, Bulusu, A, Tyler, D, White, RR, Uronis, HE, Pappas, TN & Czito, BG 2013, 'The role of local excision in invasive adenocarcinoma of the ampulla of vater', Journal of Gastrointestinal Oncology, vol. 4, no. 1, pp. 8-13. https://doi.org/10.3978/j.issn.2078-6891.2012.055
Zhong, Jim ; Palta, Manisha ; Willett, Christopher G. ; McCall, Shannon J. ; Bulusu, Anuradha ; Tyler, Douglas ; White, Rebekah R. ; Uronis, Hope E. ; Pappas, Theodore N. ; Czito, Brian G. / The role of local excision in invasive adenocarcinoma of the ampulla of vater. In: Journal of Gastrointestinal Oncology. 2013 ; Vol. 4, No. 1. pp. 8-13.
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abstract = "Background: Ampulla of Vater carcinomas are rare malignancies that have been traditionally treated with radical surgical resection. Given the mortality associated with pancreaticoduodenectomy, some patients may benefit from local resection. A single-institution outcomes analysis was performed to define the role of local resection. Methods: Patients undergoing local resection (ampullectomy) for ampullary carcinomas at Duke University between 1976 and 2010 were analyzed retrospectively. Time-to-event analysis was conducted analyzing all patients undergoing surgery, with and without adjuvant chemoradiation therapy (CRT). Overall survival (OS), local control (LC), metastases-free survival (MFS), and disease-free survival (DFS) were studied using Kaplan-Meier analysis. Results: A total of 17 patients with invasive carcinoma underwent ampullectomy. The 3-and 5-year LC, MFS, DFS and OS rates were 36{\%} and 24{\%}, 68{\%} and 54{\%}, 31{\%} and 21{\%}, and 35{\%} and 21{\%}, respectively. Patients receiving adjuvant CRT did not appear to have improved outcomes compared with surgery alone, although this group tended to have poorer histological grade, more advanced tumor staging and involved surgical margins. Conclusions: Ampullectomy for invasive ampullary adenocarcinomas is a safe procedure but does not offer satisfactory long-term results, mostly due to high local failure rates. Adjuvant CRT therapy does not appear to offer increased local control or survival benefit following ampullectomy, although these results may suffer from selection bias and small sample size. Local resection should be limited to benign ampullary lesions or patients with very small, early tumors with favorable histologic features where radical resection is not feasible.",
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AU - Palta, Manisha

AU - Willett, Christopher G.

AU - McCall, Shannon J.

AU - Bulusu, Anuradha

AU - Tyler, Douglas

AU - White, Rebekah R.

AU - Uronis, Hope E.

AU - Pappas, Theodore N.

AU - Czito, Brian G.

PY - 2013

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N2 - Background: Ampulla of Vater carcinomas are rare malignancies that have been traditionally treated with radical surgical resection. Given the mortality associated with pancreaticoduodenectomy, some patients may benefit from local resection. A single-institution outcomes analysis was performed to define the role of local resection. Methods: Patients undergoing local resection (ampullectomy) for ampullary carcinomas at Duke University between 1976 and 2010 were analyzed retrospectively. Time-to-event analysis was conducted analyzing all patients undergoing surgery, with and without adjuvant chemoradiation therapy (CRT). Overall survival (OS), local control (LC), metastases-free survival (MFS), and disease-free survival (DFS) were studied using Kaplan-Meier analysis. Results: A total of 17 patients with invasive carcinoma underwent ampullectomy. The 3-and 5-year LC, MFS, DFS and OS rates were 36% and 24%, 68% and 54%, 31% and 21%, and 35% and 21%, respectively. Patients receiving adjuvant CRT did not appear to have improved outcomes compared with surgery alone, although this group tended to have poorer histological grade, more advanced tumor staging and involved surgical margins. Conclusions: Ampullectomy for invasive ampullary adenocarcinomas is a safe procedure but does not offer satisfactory long-term results, mostly due to high local failure rates. Adjuvant CRT therapy does not appear to offer increased local control or survival benefit following ampullectomy, although these results may suffer from selection bias and small sample size. Local resection should be limited to benign ampullary lesions or patients with very small, early tumors with favorable histologic features where radical resection is not feasible.

AB - Background: Ampulla of Vater carcinomas are rare malignancies that have been traditionally treated with radical surgical resection. Given the mortality associated with pancreaticoduodenectomy, some patients may benefit from local resection. A single-institution outcomes analysis was performed to define the role of local resection. Methods: Patients undergoing local resection (ampullectomy) for ampullary carcinomas at Duke University between 1976 and 2010 were analyzed retrospectively. Time-to-event analysis was conducted analyzing all patients undergoing surgery, with and without adjuvant chemoradiation therapy (CRT). Overall survival (OS), local control (LC), metastases-free survival (MFS), and disease-free survival (DFS) were studied using Kaplan-Meier analysis. Results: A total of 17 patients with invasive carcinoma underwent ampullectomy. The 3-and 5-year LC, MFS, DFS and OS rates were 36% and 24%, 68% and 54%, 31% and 21%, and 35% and 21%, respectively. Patients receiving adjuvant CRT did not appear to have improved outcomes compared with surgery alone, although this group tended to have poorer histological grade, more advanced tumor staging and involved surgical margins. Conclusions: Ampullectomy for invasive ampullary adenocarcinomas is a safe procedure but does not offer satisfactory long-term results, mostly due to high local failure rates. Adjuvant CRT therapy does not appear to offer increased local control or survival benefit following ampullectomy, although these results may suffer from selection bias and small sample size. Local resection should be limited to benign ampullary lesions or patients with very small, early tumors with favorable histologic features where radical resection is not feasible.

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