Long-term outcomes after pancreatoduodenectomy for ampullary cancer: The influence of the histological subtypes and comparison with the other periampullary neoplasms.

Published on Mar 18, 2021in Pancreatology3.629
· DOI :10.1016/J.PAN.2021.03.005
Gennaro Nappo7
Estimated H-index: 7
Jacopo Galvanin2
Estimated H-index: 2
(Humanitas University)
+ 9 AuthorsAlessandro Zerbi57
Estimated H-index: 57
(Humanitas University)
Abstract Background Ampullary carcinoma (AC) is histologically classified as intestinal (In-AC), pancreaticobiliary (Pb-AC) or mixed-AC. The prognostic role of AC subtypes has been debated and remains unclear. The aims of this study were to evaluate outcomes after pancreatoduodenectomy (PD) for each subtype of AC and to compare these with pancreatic ductal adenocarcinoma [PDAC] and distal cholangiocarcinoma [DCC]. Methods PDs performed for AC between 2010 and 2018 were retrospectively evaluated. Histological subtype was obtained for all patients. One-year, 3-year and 5-year disease-free-survival (DFS) and overall survival (OS) rates were calculated. Kaplan-Meier survival analysis was performed to compare Pb-AC, In-AC and mixed-AC. Comparison with PDs performed for PDAC and DCC during the same period was also performed. Results A total of 97 patients undergoing PD for AC were evaluated: 34 (35.1%) In-AC, 54 (55.7%) Pb-AC and 9 mixed-AC (9.3%). DFS and OS rates for Pb-AC were significantly lower compared to In-AC (p   0.05). During the same period, 337 and 53 PDs for PDAC and DCC, respectively, were performed. In-AC was associated with significantly better outcomes compared to PDAC and DCC (p   0.05). Conclusions Pb-AC has significantly worse survival compared to In-AC. Moreover, mixed-AC should be considered as Pb-AC. Pb-AC and mixed-AC seem to have better prognosis compared to PDAC, but similar to DCC.
#1A. Moekotte (UvA: University of Amsterdam)H-Index: 6
#2Giuseppe MalleoH-Index: 43
Last. M. Abu HilalH-Index: 17
view all 32 authors...
BACKGROUND: Whether patients who undergo resection of ampullary adenocarcinoma have a survival benefit from adjuvant chemotherapy is currently unknown. The aim of this study was to compare survival between patients with and without adjuvant chemotherapy after resection of ampullary adenocarcinoma in a propensity score-matched analysis. METHODS: An international multicentre cohort study was conducted, including patients who underwent pancreatoduodenectomy for ampullary adenocarcinoma between 2006...
4 CitationsSource
#1Amr I. Al Abbas (University of Pittsburgh)H-Index: 8
#2Virginia Falvello (University of Pittsburgh)H-Index: 1
Last. Amer H. Zureikat (University of Pittsburgh)H-Index: 41
view all 9 authors...
BACKGROUND AND OBJECTIVES: Ampullary adenocarcinoma (AA) is classified by immunohistochemical (IHC) subtypes into intestinal (IN), pancreatobiliary (PB), and ambiguous (AM). The impact of adjuvant therapy on IHC subtype and disease stage is unclear. We examined the effect of adjuvant chemotherapy regimen on survival of ampullary cancers by IHC subtype and disease stage. METHODS: Review of pancreatoduodenectomy (PD) performed for AA between 2005 and 2013 at a single center. The impact of regimen ...
5 CitationsSource
#1Louisa BolmH-Index: 10
#2Kristina OhrnerH-Index: 1
Last. Ulrich F. WellnerH-Index: 30
view all 16 authors...
Abstract Background/Objective The benefit of adjuvant therapy in ampullary cancer (AMPAC) patients following pancreatoduodenectomy (PD) is debated. The aim of this study was to determine the role of adjuvant therapy after pancreatoduodenectomy (PD) in histological subtypes of AMPAC. Methods Patients undergoing PD for AMPAC at 5 high-volume European surgical centers from 1996 to 2017 were identified. Patient baseline characteristics, surgical and histopathological parameters, and long-term overal...
4 CitationsSource
#1Carolin Zimmermann (TUD: Dresden University of Technology)H-Index: 3
#2Steffen Wolk (TUD: Dresden University of Technology)H-Index: 7
Last. Marius Distler (TUD: Dresden University of Technology)H-Index: 20
view all 9 authors...
Ampullary cancer represents approximately 6% of the malignant periampullary tumors. An early occurrence of symptoms leads to a 5-year survival rate after curative surgery of 30 to 67%. In addition to the tumor stage, the immunohistological subtypes appear to be important for postoperative prognosis. The aim of this study was to analyze the different subtypes regarding their prognostic relevance. A total of 170 patients with ampullary cancer were retrospectively analyzed between 1999 until 2016 a...
24 CitationsSource
#1Brett L. Ecker (UPenn: University of Pennsylvania)H-Index: 4
#2Charles M. Vollmer (UPenn: University of Pennsylvania)H-Index: 35
Last. Paxton V. Dickson (UTHSC: University of Tennessee Health Science Center)H-Index: 13
view all 26 authors...
Importance Ampullary adenocarcinoma is a rare malignant neoplasm that arises within the duodenal ampullary complex. The role of adjuvant therapy (AT) in the treatment of ampullary adenocarcinoma has not been clearly defined. Objective To determine if long-term survival after curative-intent resection of ampullary adenocarcinoma may be improved by selection of patients for AT directed by histologic subtype. Design, Setting, and Participants This multinational, retrospective cohort study was condu...
23 CitationsSource
#1Caitlin A. Hester (UTSW: University of Texas Southwestern Medical Center)H-Index: 7
#2Epameinondas Dogeas (UTSW: University of Texas Southwestern Medical Center)H-Index: 4
Last. Adam C. Yopp (UTSW: University of Texas Southwestern Medical Center)H-Index: 36
view all 9 authors...
BACKGROUND AND OBJECTIVES: Periampullary adenocarcinoma (PAC) is stratified anatomically: ampullary adenocarcinoma (AA), distal cholangiocarcinoma (DCC), duodenal adenocarcinoma (DA), and pancreatic ductal adenocarcinoma (PDAC). We aimed to determine differences in incidence, prognosis, and treatment in stage-matched PAC patients in a longitudinal study. METHODS: PAC patients were identified in The National Cancer Database from 2004 to 2012. Clinicopathological variables were compared between su...
18 CitationsSource
#2Christian BrokatH-Index: 1
Last. Marcus Bahra (Charité)H-Index: 37
view all 8 authors...
BACKGROUND: Periampullary carcinomas generally confer a poor outcome. Choosing the most effective treatment regimen for each sub-entity proves challenging and is usually based on experience from pancreatic adenocarcinoma (PDAC). PATIENTS AND METHODS: The long-term follow-up is presented of 472 patients with periampullary tumors [PDAC, distal cholangiocarcinoma (dCC) and ampullary carcinomas (AC)] who underwent radical resection considering clinical characteristics, paraclinical findings and hist...
1 CitationsSource
#1Zhaohui Jin (Mayo Clinic)H-Index: 15
#2Mindy L. Hartgers (Mayo Clinic)H-Index: 4
Last. Amit Mahipal (Mayo Clinic)H-Index: 25
view all 11 authors...
Abstract Introduction Ampullary adenocarcinoma is a rare entity with limited data on prognostic factors. The aim of this study is to identify prognostic factors and assess the benefit of adjuvant therapy in patients with ampullary adenocarcinoma who underwent pancreatoduodenectomy. Methods A cohort of 121 consecutive patients underwent pancreatoduodenectomy for ampullary adenocarcinoma from 2006 to 2016 at Mayo Clinic in Rochester, MN. All patients were confirmed by independent pathologic review...
19 CitationsSource
#1Ibrahim Nassour (UTSW: University of Texas Southwestern Medical Center)H-Index: 15
#2Linda S. Hynan (UTSW: University of Texas Southwestern Medical Center)H-Index: 69
Last. Sam C. Wang (UTSW: University of Texas Southwestern Medical Center)H-Index: 21
view all 9 authors...
Background There are limited data on the efficacy of adjuvant therapy in ampullary cancer. The aim of this study was to determine whether adjuvant therapy was associated with improved survival for patients with ampullary cancer.
17 CitationsSource
#1Claudio BassiH-Index: 110
Last. M.W. Büchler (Heidelberg University)H-Index: 79
view all 33 authors...
Background In 2005, the International Study Group of Pancreatic Fistula developed a definition and grading of postoperative pancreatic fistula that has been accepted universally. Eleven years later, because postoperative pancreatic fistula remains one of the most relevant and harmful complications of pancreatic operation, the International Study Group of Pancreatic Fistula classification has become the gold standard in defining postoperative pancreatic fistula in clinical practice. The aim of th...
1,074 CitationsSource
Cited By0