CARCINOMA OF THE AMPULLA OF VATER - PROGNOSTIC FACTORS AFTER CURATIVESURGERY - A SERIES OF 45 CASES

Background-Some adjuvant or neo-adjuvant therapy could be important fo r patients operated on for tumours of the ampulla of Vater, especially for those having a higher risk of recurrence. Aim-To evaluate prognos tic factors after curative surgery based on a series of 45 cases of ma lignant tumours of the Oddi sphincter. Patients-From 1970 to 1992, a c urative resection was performed in 45 patients (age 62 . 8 (SD 10 . 1) years) with adenocarcinoma of the ampulla. Surgical procedures includ ed pancreatoduodenectomy (n=42) and resection of the ampulla (n=3). Ac tuarial survival was 44 (SD 9)% at five years. Methods-Various prognos tic variables were studied: clinical manifestations, macroscopic aspec t, differentiation, noninvasive adenomatous component, mucin histochem istry, immunohistochemistry (CEA, CA19.9, p53, Ki67), and accepted cla ssifications (Blumgart and Kennedy, Martin, Yamaguchi and Enjoji, Talb ot et al, pTNM). Results-Variables with prognostic power, in order of importance were: Classification of Talbot ef al; CA19.9; pTNM; sialomu cins; classification of Yamaguchi and Ejoji; Martin classification; su lphomucins; non-invasive adenomatous component (positive>negative); ja undice; tumour localisation. Conclusions-This series confirmed the pro gnostic power of former classifications and showed the prognostic powe r of other variables (mucin, non-invasive adenomatous component, CA19. 9).