RESULTS OF PANCREATICODUODENECTOMY FOR AMPULLARY CARCINOMA AND ANALYSIS OF PROGNOSTIC FACTORS FOR SURVIVAL

Background. Results of pancreaticoduodenectomy for ampullary carcinoma were evaluated, and prognostic factors far survival were analyzed. Me thods. During the period from 1984 to 1992 67 patients underwent subto tal or total pancreaticoduodenectomy for ampullary carcinoma. All clin icopathologic data and their influence on survival were studied. Resul ts. Subtotal pancreaticoduodenectomy was performed in 62 of 67 patient s with a mortality of 6% and a morbidity of 65%; the remaining five pa tients underwent total pancreaticoduodenectomy. Intraabdominal infecti on was the most important complication. Resection margins were tumor f ree in 75% of 67 patients. The overall 5-year survival was 50%. Surviv al was significantly influenced by the involvement of resection margin s. After resection with involved margins 5-year survival was 15% and 6 0% after resection with free margins (p < 0.001). Tumor size, lymph no de involvement, and differentiation grade had limited and not signific ant influence on survival. Conclusions. Subtotal pancreaticoduodenecto my is the type of resection of first choice for ampullary carcinoma. I nvolvement of resection margins was the strongest prognostic factor fo r survival. Patients with a tumor size larger than 2 cm, with lymph no de involvement, or with a poorly differentiated tumor still had a 5-ye ar survival rate greater than 40%. Patients with involved margins migh t be candidates for studies on adjuvant therapy.