ADENOCARCINOMA OF THE AMPULLA OF VATER - A 28-YEAR EXPERIENCE

Objective The aims of this study were to review the experience with ad enocarcinoma of the ampulla of Vater at The Johns Hopkins Hospital and to determine what factors influenced the longterm outcome in these pa tients. Summary Background Data Adenocarcinoma of the ampulla of Vater is the second most common periampullary malignancy. However, most ser ies have relatively small numbers. As a result, analysis of factors in fluencing outcome has been limited. Methods From 1969 to 1996, 120 pat ients with adenocarcinoma of the ampulla of Vater were managed at The Johns Hopkins Hospital. Clinical, operative, and pathologic factors we re correlated with morbidity and long-term survival. Factors influenci ng outcome were evaluated by univariate and multivariate analyses. Res ults Resection was performed in 106 patients (88%), and 105 of these p atients (99%) underwent either pancreatoduodenal resection (n = 103) o r total pancreatectomy (n = 2). Resection rate increased from 62% in t he 1970s to 82% in the 1980s to 96% in the 1990s (p < 0.05). Overall m ortality after resection was 3.8% with no mortality in the 45 consecut ive patients resected in the past 5 years. Morbidity also decreased si gnificantly (p ( 0.05) from 70% before to 38% after December 1992. Fiv e-year survival for resected patients was 38%. Factors favorably influ encing 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 multivaria te analysis, the best predictor of prolonged survival was absence of i ntraoperative transfusion (p = 0.06, relative risk = 1.90, 95% confide nce limits = 0.95-3.78). Conclusions Compared to carcinoma of the panc reas, carcinoma of the ampulla of Vater has a higher resectability rat e and a better prognosis. Early diagnosis is important because lymph n ode status influences survival. Careful operative dissection and avoid ance of transfusions also improves long-term survival.