A Five-Year Survivor without Recurrence Following Robotic Anterior Radical Antegrade Modular Pancreatosplenectomy for a Well-Selected Left-Sided Pancreatic Cancer

Radical antegrade modular pancreatosplenectomy (RAMPS) is regarded as a reasonable approach for margin-negative and systemic lymph node clearance in left-sided pancreatic cancer. We present a patient with more than 5 years disease-free survival after robotic anterior RAMPS for pancreatic ductal adenocarcinoma in the body of the pancreas. The distal part of pancreas, soft tissue around the celiac trunk, and the origin of splenic vessels was dissected with the underlying fascia between the pancreas and adrenal gland. Resected specimen was removed through small vertical abdominal incision. Robot working time was about 8 hours, and blood loss was about 700 mL without blood transfusion. He returned to an oral diet on the postoperative first day and recovered without any clinically relevant complications. There was no lymph node metastasis, perineural or lymphovascular invasion. Both the pancreatic resection margin and the tangential posterior margin were free of carcinoma. The patient received only postoperative adjuvant radiotherapy around the tumor bed. The patient has survived for more than 5 years without evidence of cancer recurrence. Minimally invasive radical left-sided pancreatectomy with splenectomy may be oncologically feasible in well-selected pancreatic cancer.

Robotic pylorus preserving pancreaticoduodenectomy with mini-laparotomy reconstruction in patient with ampullary adenoma / 대한외과학회지

Robotic surgical system provides many unique advantages which might compensate the limitations of usual laparoscopic surgery. By using robotic surgical system, we performed robot-assisted laparoscopic pancreaticoduodenectomy (PD). A Sixty-two year old female patient with an ampullary mass underwent robot assisted PD due to imcomplete treatment of endoscopic ampullectomy. The removal of specimen and reconstruction were performed through small upper midline skin incision. Robot working time was about 8 hours, and blood loss was about 800 ml without blood transfusion. She returned to an oral diet on postoperative day 3. Grade B pancreatic leak was noted during the postoperative period, but was successfully managed by conservative management alone. We successfully performed da Vinci-assisted laparoscopic PD, and robot surgical system provided three-dimensional stable visualization and wrist-like motion of instrument facilitated complex operative procedures. More experiences are necessary to address real role of robot in far advanced laparoscopic pancreatic surgery.

Robotic pylorus preserving pancreaticoduodenectomy with mini-laparotomy reconstruction in patient with ampullary adenoma / 대한외과학회지

Robotic surgical system provides many unique advantages which might compensate the limitations of usual laparoscopic surgery. By using robotic surgical system, we performed robot-assisted laparoscopic pancreaticoduodenectomy (PD). A Sixty-two year old female patient with an ampullary mass underwent robot assisted PD due to imcomplete treatment of endoscopic ampullectomy. The removal of specimen and reconstruction were performed through small upper midline skin incision. Robot working time was about 8 hours, and blood loss was about 800 ml without blood transfusion. She returned to an oral diet on postoperative day 3. Grade B pancreatic leak was noted during the postoperative period, but was successfully managed by conservative management alone. We successfully performed da Vinci-assisted laparoscopic PD, and robot surgical system provided three-dimensional stable visualization and wrist-like motion of instrument facilitated complex operative procedures. More experiences are necessary to address real role of robot in far advanced laparoscopic pancreatic surgery.

The First Experience of Robot Assisted Spleen-Preserving Laparoscopic Distal Pancreatectomy in Korea

Spleen-preservation has recently been emphasized in benign and borderline malignant pancreatic diseases requiring distal pancreatectomy. Reports to suggest that laparoscopic distal pancreatectomy is feasible and safe have been increasingly published. Robotic surgical system has been introduced and is expected to provide unique advantages in laparoscopic surgery. However, robot-assisted pancreatic surgery has not yet been performed by many surgeons. A 45-year-old female patient with abdominal discomfort was found to have pancreatic cyst in the body of the pancreas. Mucinous cystic tumor of the pancreas was the most favourable preoperative diagnosis. She underwent spleen-preserving laparoscopic distal pancreatectomy by using da Vinci surgical robot system. Splenic artery and vein were so tightly adherent to the pancreatic cyst that segmental resection of splenic vessels was required. Postoperative course was uneventful. She was able to come home in 5 days after surgery. Postoperative follow up color doppler ultrasound scan, taken on 2 weeks after surgery, showed minimal fluid collection around surgical field and no evidence of splenic infarction with good preservation of splenic perfusion. Robot-assisted spleen preserving distal pancreatectomy is thought to be feasible and safe. Several unique advantages of robotic system are expected to enhance safer and more precise surgical performance in near future. More experiences are mandatory to confirm real benefit of robot surgery in pancreatic disease.

"Extended" Distal Pancreatectomy with Segmental Resection of Both Splenic Vessels; Extended Warshaw's Procedure

PURPOSE: We would like to assess the safety and feasibility of extended spleen-preserving distal pancreatectomy with segmental resection of both splenic vessels (SPDP-SRSV) in patients with large, benign and borderline malignant pancreas body tumors. METHODS: We encountered seven extended SPDP-SRSV cases from January 2006 to March 2010. Among them, three were excluded due to combined pylorus-reserving pancreaticoduodenectomy (PPPD). For the extended surgical technique, the pancreas was divided above the confluence of the superior mesenteric vein-splenic vein-portal vein (SMV-SV-PV), and vascular control was achieved at the origin of the splenic artery and the junction of the splenic vein with the SMV. The segments of both splenic vessels were then extracted along with the specimen. RESULTS: All the patients were female with a median age of 57 years (range: 24~70 years). The median tumor size was 5.5 cm (range: 5~11 cm), the median operation time was 362 minutes (range: 337~441 min), the median estimated blood loss was 150 ml (range: 50~300 ml) and the median hospital stay was 9 days (range: 7~20 days). One patient underwent robot-assisted extended Warshaw procedures. No mortality was noted, but one partial intestinal obstruction occurred and this was resolved with conservative management. On the recent follow-up, the CT scans showed no evidence of tumor recurrence or spleen infarction, but newly developed perigastric varix was noted, but it was without variceal bleeding. CONCLUSION: SPDP-SRSV with division of the pancreatic neck portion above the confluence of the SMV-SV-PV in patients with large, benign and borderline malignant pancreatic body tumors appears to be an ideal approach because of the expected long-term survival and preserving the role of the spleen.

Renal Carcinoma Cell Metastasis into Pancreas : A Single Center Experience

INTRODUCTION: Renal cell carcinoma (RCC) is a relative rare tumor, accounting for approximately 3% of adult malignancies. Renal cell carcinoma has a high metastatic potential and is renowned for its ability to spread to almost any organ of the body. Pancreas is a rare site for metastasis from other primary cancers. Moreover, pancreatic metastasis is difficult to differentiate and may be misdiagnosed as a primary pancreatic cancer. The aim of this study was to review our cases of renal cell carcinoma that had metastasized to the pancreas after radical nephrectomy. METHODS: We did a retrospective review of the records of 4 patients with pathologically confirmed RCC that had metastasized to the pancreas after radical nephrectomy. RESULTS: Our group of 4 patients consisted of 2 men and 2 women. Their average age was 58.7 years (+/- 10.51 years). The locations within the pancreas were the head, in 2 (50.0%) and the body/tail in 2 (50.0%) patients. The pancreatic metastases were treated by pancreaticoduodenectomy in 2 patients, and by distal pancreatectomy in 2 patients. Median survival duration was 109.0 (+/- 67.3 months) "Median" is associated with an interquartile range (25% to 75%). The number 67.3 appears to be a standard deviation which is associated with the "mean". CONCLUSIONS: RCC is an unpredictable tumor that may result in a late metastasis even from an early stage. Aggressive surgical management of pancreatic lesions offers a chance of long-term survival.

Medical Care Quality Improvement on the Groundwork of National Healthcare Insurance Financial Stability

According to 2005 OECD health data, the total Korean expenditure on health in percentage of GDP is 6%, while other OECD countries spend an average 10% of their GDP. Accordingly, health and medical professionals uniformly point out that the idea of 'proper medical treatment with a reasonable fee' is unfair. Hence, the rationalization of the national health insurance rate is a step toward the financial stability of the national health insurance system and a way to further the realization of proper medical care. The importance of strengthening national health insurance coverage through financial expansion on the national health insurance system should be recognized as an urgent social and political issue.

Initial Experience with Laparoscopic and DaVinci Robotic-assisted Liver Resection

PURPOSE: Although laparoscopic surgery has become more popular, its technical difficulties have limited the applications of this technique to liver surgery. We report here on our experience with liver resection with perfoming laparoscopic assisted and DaVinci robot assisted hepatectomy. METHODS: We retrospectively evaluated 40 patients who underwent laparoscopic assisted and DaVinci robotic assisted hepatectomy at the Yonsei University Health System from January 2002 to January 2008. RESULTS: Thirty patients (75%) had malignancy and ten patients (15%) had benign disease. We performed Lt. hepatectomy (7.5%), wedge resection (17.5%), segmentectomy (30%) and Lt. lateral segmentectomy (45%). The rate of conversion to laparotomy was due to intraoperative bleeding was 10%. The complication and mortality rates were 7.5% and 0%, respectively CONCLUSION: Laparoscopic and DaVinci robot hepatectomy showed a reduced time to oral intake, a shortened hospital stay and a smaller incisional scar compared to open surgery. So, laparoscopic and DaVinci robot hepatectomy should be performed in selected patients as the postoperative status of the patients is better than that with performing open hepatectomy.

Ki-67 and VEGF as Possible Prognostic Factors in Radically-resected Ampulla of Vater Cancer

PURPOSE: Ampulla of Vater cancer has a more favorable prognosis and survival than other malignant periampullary tumors. The pathologic staging of ampulla of Vater carcinoma is a key determinant of the patient's prognosis. However, we have often encountered patients in whom the course of their disease differed substantially from what would be predicted based on their clinical staging, which highlights the need to consider additional predictive factors. We applied an immunohistochemical technique to examine the expression of Ki-67 and VEGF in radicallyresected ampulla of Vater carcinomas, and then compared the status of expression with several clinicopathologic factors. METHODS: Sixty-four patients who underwent curative resection for ampulla of Vater cancer between January 1992 and December 2006 at the Yonsei University College of Medicine were reviewed. The relationships between the expression of molecular markers and clinicopathologic factors were determined. RESULTS: There was no relationship between the clinicopathologic characteristics and the expression of molecular markers in patients with ampulla of Vater cancer. Among the clinicopathologic characteristics, lymph node metastasis was identified as an independent factor of survival after curative resection for ampulla of Vater carcinoma. CONCLUSION: Measurement of Ki-67 and VEGF in patients with ampulla of Vater carcinoma may have an important role in identifying the poor prognostic group.

The First Korean Experience of Telemanipulative Robot-Assisted Laparoscopic Cholecystectomy Using the da Vinci System

With the advancement of laparoscopic instruments and computer sciences, complex surgical procedures are expected to be safely performed by robot assisted telemanipulative laparoscopic surgery. The da Vinci system (Intuitive Surgical, Mountain View, CA, USA) became available at the many surgical fields. The wrist like movements of the instrument's tip, as well as 3-dimensional vision, could be expected to facilitate more complex laparoscopic procedure. Here, we present the first Korean experience of da Vinci robotic assisted laparoscopic cholecystectomy and discuss the introduction and perspectives of this robotic system.

Analysis of Prognostic Factors after Curative Resection for Gallbladder Carcinoma / 대한소화기학회지

BACKGROUND/AIMS: Despite the development in diagnostic tools, gallbladder carcinoma is often diagnosed at an advanced stage. Therefore, early diagnosis and radical resection are most important factors for the prognosis of gallbladder carcinoma. However, prognostic factors after radical resection of gallbladder carcinoma have not been well identified. The aim of this study was to evaluate the prognostic factors of gallbladder carcinoma after curative resection. METHODS: We reviewed the records of the 115 patients with gallbladder carcinoma who underwent curative surgery between 1989 and 2004 at Yonsei University Medical Center (YUMC). The relationship between survival and clinicopathological variables was assessed. RESULTS: In 311 patients presenting with gallbladder carcinoma, 195 patients (62.5%) were radically resected. Among 195 patients, 80 patients were excluded because of incomplete clinicopathologic data and unsatisfactory follow-up. The 5 year overall survival rate was 36.0%, and disease free 5 year survival rate was 3.9%. Univariate analysis showed that survival was closely related to gross morphology, depth of tumor invasion, lymph node metastasis and preoperative serum CA19-9 level. Three significant factors identified by multivariate analysis were depth of tumor invasion, gross morphology, and preoperative serum CA19-9 level. CONLUSIONS: Depth of tumor invasion, gross morphology, and preoperative serum CA19-9 level are independent significant prognostic factors of resectable gallbladder carcinoma.

Treatment Modalities for Adrenal Metastasis from Hepatocellular Carcinoma

PURPOSE: The adrenal gland is one of most the common sites for an extrahepatic metastasis from a hepatocellular carcinoma (HCC). However, there are no definitive guidelines for the treatment of adrenal metastasis. This study examined the effect of each therapeutic modality in an attempt to clarify the treatment strategy for adrenal metastases from a HCC. METHODS: This study reviewed the records of 11,770 consecutive HCC patients in the Yonsei University Medical Center from 1991 to 2005. Among the 11,770 patients, 648 were diagnosed with an extrahepatic metastasis. Of the extrahepatic metastases, 45 (6.9%) had an adrenal metastasis. Among these 45 patients, 15 patients with multiorgan metastases including the adrenal gland were excluded leaving 30 patients for review. The survival duration was evaluated according to the treatment modality, which included an adrenalectomy, non-surgical treatment (TACE, Chemotherapy), and conservative treatment. RESULTS: There were 24 men and 6 women, and the average age was 52.3 years (+/-9.1 years). The location of the adrenal metastasis was in the Rt, Lt, and both glands in 17 (56.7%), 9 (30.0%), and 4 (13.3%) patients, respectively. The initial HCC had been treated by a hepatectomy in 6 patients, and by non-surgical treatments such as TACE, chemotherapy and radiotherapy in 24 patients. The adrenal metastasis was treated by an adrenalectomy in 5 patients, by non-surgical treatment in 19 patients, and by conservative treatment in 6 patients. The overall median survival duration in the 30 cases was 11.1 months. The median survival time of the adrenalectomy, non-surgical treatment and conservative treatment groups was 21.4 months, 11.1 months, and 2.2 months respectively. The difference in the cumulative survival according to the treatment modality was statistically significant. CONCLUSION: The prognosis of an adrenal metastasis from HCC is quite poor. However, an adrenalectomy for an adrenal metastasis from a HCC is a safe procedure, and an acceptable way of achieving long-term survival.

Putative Tumor Suppressor Gene Loci onChromosome 20q in Intrahepatic Cholangiocellular Carcinoma that were Found by Microsatellite Marker Analysis

PURPOSE: Intrahepatic cholangiocellular carcinoma (ICC) is the second most common malignant tumor in the liver, and it arises from epithelial cells in the intrahepatic bile duct. While the reported risk factors include liver fluke infection, hepatolithiasis and sclerosing cholangitis, the genetic mechanisms involved in the development of ICC are not well understood, and only a few cytogenetic studies of ICC have been published. We recently found genetic imbalance on chromosome 20q in ICC with using Comparative Genomic Hybridization. So, we tried to find gene loci on chromosome 20q. (ED note: what kind of loci were you looking for) METHODS: We used 16 fresh frozen ICC tumor tissues and the paired normal liver tissues for DNA extraction. A set of primers for 10 microsatellite loci on chromosome 20q13-qter, based on an updated GeneMap99 and Ensemble, was purchased from Research Genetics. The markers selected for testing exhibited high levels of heterozygosity and relatively uniform distributions. Loss of heterozygosity (LOH) was analyzed by an automatic DNA analyzer. Using the Ensemble Web site, mining of putative tumor suppressor genes were developed between microsatellite markers that showed LOH. RESULTS: In one case, microsatellite instability (MSI) was found in all the markers except D20S196, and MSI was found in only one marker, d20S196, in another case. (Ed note: check this and it wasn't clear.) The most frequent region which have LOH on chromosome 20q13-qter was on D20S109 and D20S196, and their invidence was 12.5%. (ED note: the last part of the sentence makes no sense at all. You have to rewrite it.) D20S174, D20S107, D20S170, D20S96 and D20S119 were 6.3% and D20S836, D20S886 and D20S were 0%. (ED note: this sentence also makes no sense. They were 6% and 0% of what?) We found eight genes between D20S109 and D20S196: PTPN1, QSNf41 HUMAN, CT175 HUMAN, PARD6B, BCAS4, TMSL6, ADNP and DPM1. Among these, PTPN1, PARD6B and BCAS4 are well known oncogenes, so the other five genes are thought to be putative tumor suppressor genes. CONCLUSION: Using this approach, we identified two distinctive allelic losses defined by microsatellite markers as follows; D20S109 and D20S196. We identified five genes which can make contribution to the development or progression of intrahepatic cholangiocellular carcinoma. Further study will be carried out to confirm these genes have a critical role in the development or progression of intrahepatic cholangiocellular carcinoma using immunohistochemical study or other molecular biology work.

Clinical Characteristics of Sarcomatoid HCC in Single Hospital Experience

PURPOSE: Sarcomatoid hepatocellular carcinoma (HCC) is a rare neoplasm and it has been found in only 1.8% of the surgically resected HCC patients, and in only 3.4~9.4% of the autopsied HCC cases. The pathogenesis of this tumor has't yet been thoroughly clarified, and such a tumor has been variously referred to as spindle cell carcinoma, sarcomatoid carcinoma, pseudosarcoma, or carcinosarcoma. There is only a little difference between the clinical characteristics of the sarcomatoid HCC and those of ordinary HCC. The diagnosis of the sarcomatoid HCC is made by pathological and immunohistochemical techniques after surgical resection, biopsy, or autopsy. METHODS: We reviewed the 10 cases of pathologically confirmed sarcomatoid HCC that were registered at the Yonsei University Medical Center from 1992 to 2004. RESULTS: Surgical operation was performed in seven cases, and curative resection was done only in five. Three patients were treated with chemotherapy or transarterial chemoem-bolization (TACE) with or without concurrent radiotherapy after the diagnosis of sarcomatoid HCC by liver biopsy. Six patients expired within 4 months after the diagnosis. The 6 month and 12 month survival rates for sarcomatoid HCC were 40% and 20%, respectively. The 6 month survival rates for radical resection and non-radical resection were 60% and 0%, respectively. The difference in cumulative survival according to the treatment of sarcomatoid HCC was statistically significant. CONCLUSION: The prognosis of sarcomatoid HCC is very poor; therefore, curative resection, adjuvant chemoradiotherapy, and close follow-up are necessary for patients suffering with sarcomatoid HCC.

Clinical Significance of p16 Protein Expression Loss and Aberrant p53 Protein Expression in Pancreatic Cancer

Pancreatic cancer is a disease with poor prognosis mainly due to low resection rates and late diagnosis. To increase resectability and improve survival rates, a better understanding of pancreatic cancer pathogenesis and more effective screening techniques are required. New methods, such as genetic and molecular alterations, may suggest novel approaches for pancreatic cancer diagnosis and treatment. We immunohistochemically investigated 44 formalin-fixed, paraffin-embedded specimens of pancreatic ductal adenocarcinoma using monoclonal anti-p16 antibodies and monoclonal anti-p53 antibodies. The expressions of p16 and p53 proteins were compared using the Chi-square test with SPSS. Disease-free survival was analyzed using the Kaplan-Meier method, verified by the Log- Rank test. Loss of p16 expression was noted in 20 (45.5%) cases and aberrant p53 protein expression was detected in 14 (31.8%) cases. Loss of p16 expression was associated with a higher incidence of lymph node metastasis (p=0.040) and a more advanced stage (p=0.015), although there was no significant correlation between p16 expression and survival. Aberrant p53 protein expression correlated with histologic grade (p= 0.038). Disease-free survival rate was significantly lower in the aberrant p53 protein positive group compared to the negative group (p=0.029). From our results, we suggest that p53 is not a prognostic factor; however, p16 and p53 genes do play important roles in the progression of pancreatic ductal adenocarcinoma.

Recurrence Patterns and Risk Factors after Curative Resection in Stage II Gallbladder Carcinoma

PURPOSE: Despite the advances in hepatobiliary imaging techniques, most patients with a gall bladder carcinoma are diagnosed at an advanced stage, with a very poor prognosis. Recent studies have shown that aggressive radical resection for an advanced stage gallbladder carcinoma can give an acceptable prognosis. However, recurrence frequently remains the main problem after a curative resection of an advanced stage gallbladder carcinoma. The aim of this study was to identify the patterns of recurrence and factors affecting recurrence after a curative resection for a stage II gallbladder carcinoma. METHODS: Between January 1991 and December 2003, 100 patients received a radical curative resection for a gallbladder carcinoma at the Yonsei University Medical Center. Of these, 77 were defined with a stage II gallbladder carcinoma according to the UICC classification (6th edition). Of the 77 patients, 67 were reviewed, and the predictors of tumor recurrence analyzed. RESULTS: Among the 67 patients, 38 (56.7%) suffered a recurrence. The mean length to the recurrence was 21.1 months (+/- 26.7 months), with the most common site being the intra- abdominal organs: liver and aortocaval lymph nodes. Infiltrating and poorly differentiated types were identified as independent prognostic factors of a recurrence after a curative resection for a stage II gallbladder carcinoma. CONCLUSION: In conclusion, as a higher probability of recurrence is anticipated in cases of infiltrating and poorly differentiated types of tumor support the need for the development of an effective postoperative adjuvant modality for this high risk group of patients.

Recurrence Patterns and Risk Factors of Early Recurrence after Curative Resection of Ampulla of Vater Cancer

PURPOSE: Carcinomas of the ampulla of Vater have a higher resection rate, lower recurrence rate and more favorable prognosis than other malignant tumors of the periampullary region. This is because they usually presents with symptoms at an early stage due to their special anatomic location. Because of their relative low incidence, there have been few reports on the patterns and risk factors of a recurrence after a curative resection. The aim of this study was to evaluate the patterns and risk factors of a recurrence after a curative resection of ampulla of Vater cancer. METHODS: The medical records of 87 regularly followed-up patients from a total of 102 patients with a carcinoma of the ampulla of Vater, who had undergone a curative surgery between January 1992 and December 2002, were retrospectively reviewed. Of these patients, 37 were diagnosed as recurrent, with the patterns and clinicopathological risk factors of the recurrence analyzed. RESULTS: The average time to recurrence after a curative resection was 29.3+/-35.3 months, with liver metastasis being the most frequent (40.5%). The mean age of the patients in which a recurrence occurred was 54.9+/-10.1 years. There were 18 male and 19 female patients. The average tumor size in the recurred group was 2.5+/-2.0 cm. The recurrences were classified as early and late if they occurred within 18 months and after 18 months, respectively. The risk factors affecting an early recurrence were the gross morphology of tumor(ulcer formation) and cell differentiation (poorly differentiated). A univariate analysis showed lymph node metastasis to be a statistically significant risk factor, but age, gender, degree of tumor invasion depth and cell differentiation were not statistically significant. CONCLUSION: Lymph node metastasis is the most important risk factor affecting a recurrence after a curative resection of ampulla of Vater cancer, with the tumor gross morphology and cell differentiation important factors in an early recurrence. Further study on postoperative chemotherapy or radiotherapy in patients with lymph node metastasis, an ulcerative tumor type or poorly differentiated cell type, with a long-term follow-up on many patients will be needed.

Transduodenal Local Resection for Low Risk Group Ampulla of Vater Cancer Patients

PURPOSE: A carcinoma of the ampulla of Vater has more favorable prognosis than other malignant tumors of the periampullary region, because it is symptomatic at an early stage. However, local resection of an ampullary carcinoma remains controversial. The aim of this study was to evaluate the treatment results of ampulla of Vater carcinomas, according to operation type in low risk group patients. METHODS: The records of 17 low risk group patients, among 120 patients with ampulla of Vater cancer, who underwent curative surgery beyween 1992 and 2002, were reviewed. All specimens were critically reviewed by a single expert pathologist. The relationship between surgical outcomes and operation type were assessed. RESULTS: There were 10 men and 7 women, with a median age of 57.8 years. 13 of the 17 patients underwent the Whipples operation or a PPPD, and 4 underwent a transduodenal local resection (TDLR). The operation time was shorter in the TDLR group, and was statistically significant. Among the 17 patients, only one had a recurrence in the inguinal area 33 months after the PD. CONCLUSION: Transduodenal local resection is a recommendable operation for low risk Ampulla of Vater cancer patients. During the operation, it is essential to accurately evaluate the depth of invasion, cell differentiation and positivity of the resection margin using frozen sections.

Prognostic Factors and Survival Rate of Ampulla of Vater Cancer after Curative Surgery

PURPOSE: Ampulla of Vater cancer has a more favorable prognosis than other malignant tumors of the periampullary region, but prognostic factors have not been identified. The aim of this study was to evaluate the prognostic factors of ampulla of Vater cancer from a single hospital experience. METHODS: The medical records of the 102 patients with ampulla of Vater cancer which underwent curative surgery between 1992 and 2002, were reviewed. All specimens were critically reviewed by an expert pathologist. The relationships between survival and the clinicopathological variables were assessed. RESULTS: In 120 patients that presented with ampulla of Vater cancer, 102 (85%) were resected. The 5 year survival rate was 69.1%. A univariate analysis showed the survival was closely related to gender, the tumor gross morphology, invasion depth and lymph node metastasis. A multivariate analysis identified two significant factors; the depth of invasion and gender. Twenty nine of the 102 patients suffered a recurrence. CONCLUSION: The depth of invasion and gender were independent significant prognostic factors of resectable ampulla of Vater cancer. Careful observation is essential for liver metastasis after surgery, especially in patients that have these factors.

In Honor of the JKMA

No abstract available.