Pancreaticoduodenectomy for ampullary carcinoma

Thirty-two consecutive patients with adenocarcinoma pf the ampulla of Vater who had curative resection by pancreaticoduodenectomy were analyzed to det ermine the accuracy of preoperative investigations and factors that influen ced survival. Obstructive jaundice was present in 31 patients, and most pat ients had pain and weight loss. Ultrasound vias more useful than CT in iden tifying biliary obstruction, whereas CT was more accurate in demonstrating pancreatic duct dilatation and an ampullary mass. Endoscopic retrograde cho langiopancreatography with biopsy and brush cytology was the most accurate investigation and proved or was suspicious of carcinoma in all patients. Ni neteen patients had postoperative complications, three of whom died (9.4%)- two of sepsis and one from aspiration following hematemesis. Actuarial 5-ye ar survival was 46 per cent. Stage of disease was the strongest predictor o f survival. All patients with T-1 lesions are alive more than 5 years after resection. Patients with lymph node metastases had a significantly shorter survival than node-negative patients (P = 0.00087). Pancreaticoduodenectom y is advocated for ampullary carcinoma in good-risk patients, with the anti cipation of prolonged survival in those with early (T-1) lesions and node-n egative disease.