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Ampullary carcinoma is a rare malignant tumor of the digestive tract. Compared with other malignant tumors around the ampulla, its prognosis is significantly better, but the prognosis of some patients with ampulla cancer is unsatisfactory. Studies have confirmed that the systemic inflammatory response is closely related to the prognosis and efficacy of tumors, and the tumor microenvironment plays a vital role in tumor progression and prognosis. In recent years, inflammatory parameters and related prediction models have become a hot spot in predicting the prognosis and survival of ampullary cancer, and they have been confirmed to have certain predictive value. This article reviews the correlation between inflammatory parameters and prognosis of ampullary carcinoma and presents the possible progress for future research.
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Objective:To identify the risk factors of clinically relevant pancreatic fistula (CR-POPF) after pancreaticoduodenectomy (PD) for Vater′s ampullary carcinoma.Methods:The clinical data of 93 Vater's ampullary carcinoma patients who had undergone PD in Nanjing Drum Tower Hospital from January 2018 to December 2020 was retrospectively analyzed. According to the occurrence of CR-POPF, all patients were divided into the CR-POPF group and no CR-POPF group. Univariate analysis and multivariate analysis by logistic regression model were performed for perioperative risk factors of CR-POPF to identify the independent risk factors for CR-POPF after PD for Vater's ampullary carcinoma.Results:44 patients developed CR-POPF and the rate of CR-POPF was 47.3%(44/93). The most frequently detected microorganisms from abdominal drain fluid after operation were Klebsiella pneumoniae (25.8%), Enterococcus faecalis (19.4%), Enterobacter cloacae (11.8%) and Enterococcus faecium (10.7%). The results of univariate analysis showed that operation time, C-reactive protein (CRP) on postoperative day (POD)1, Klebsiella pneumoniae, Enterococcus faecalis and Enterococcus faecium in the abdominal drainage were statistically different between the two groups (all P value <0.05). Multivariate analysis revealed that CRP on POD1 ( OR 1.029, 95% CI 1.003-1.055, P=0.026), Klebsiella pneumoniae( OR 8.671, 95% CI 2.366-31.772, P=0.001), Enterococcus faecalis( OR 10.497, 95% CI 2.306-41.776, P=0.002) and Enterococcus faecium ( OR 22.580, 95% CI 2.303-221.403, P=0.007) in the abdominal drainage were independent risk factors for the development of CR-POPF after PD for Vater′s ampullary carcinoma. Conclusions:CRP on POD1, Klebsiella pneumoniae, Enterococcus faecalis and Enterococcus faecium in the drain samples were independent risk factors for the development of CR-POPF after PD for Vater′s ampullary carcinoma.
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The study included endoscopic duodenal biopsies received in the department of pathology, MMIMSR,Mullana, Haryana. 44 biopsies were included in the study. The most common presenting complaintwas pain abdomen followed by diarrhea. The neoplastic lesions commonly presented as carcinomawhereas the non-neoplastic lesions presented as inflammatory lesions on endoscopy. Non-neoplasticlesions were found to be common with villous atrophy predominating the list. Majority of the lesionswere non-neoplastic, presenting with pain abdomen & inflammatory findings on endoscopy. Theneoplastic lesions comprised of adenocarcinoma. A single case of ampullary carcinoma was alsonoted. Percentage of concordance between endoscopic & histologic diagnoses was calculated whereinduodenitis, scalloping, polypoidal & carcinomatous lesions showed 100%, 60.7%, 0% & 100%concordance between the two diagnostic modalities respectively. The conclusion of the study wasthat endoscopic examination alone might miss out in diagnosing majority of the lesions. So, histologicalexamination in adjunct with endoscopy should be considered as much more valuable diagnostic toolrather than endoscopy alone.
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Objective To investigate the value of multiple sequential MRI in the differential diagnosis of vater ampulla carcinoma (VPC).Methods MRI data of 53 patients with VPC confirmed by surgery and pathology were analyzed retrospectively,which included 17ampullary carcinomas,15 pancreatic head carcinomas,10 duodenal papillary carcinomas and 11 distal common bile duct carcinomas.All patients underwent routine MRI plain scan,MRCP and multi-phase dynamic enhancement scan for the upper abdomen.The morphological characteristics and model of multi-phase dynamic enhancement of the tumor,and the morphological changes of pancreaticobiliary duct were focused,and relevant data were also measured.Results The differences of tumor size,central location,and signal homogeneity among the four different histological types showed statistical significance(P＜0.05),and their patterns of multi-phase dynamic enhancement also had differences.Double-segment sign was most found in VPC (26/53),four-segment sign was easy showed in pancreatic head carcinoma (8/15)and three-segment sign in distal common bile duct carcinoma (8/11).Beak sign was common seen in ampullary carcinoma(10/17),rat-tail sign was easy discovered in pancreatic head carcinoma (7/15) and truncated sign in distal common bile duct carcinoma(10/11).Diameter of major pancreatic duct in pancreatic head carcinoma was maximum and minimum in distal common bile duct carcinoma,and their difference had statistical significance(P＜0.05).Distance between obstructive end of bile common duct and major papilla of duodenum,and between obstructive end of major pancreatic duct and major papilla of duodenum as well as the pancreaticobiliary conjunction angle in pancreatic head carcinoma and distal common bile duct carcinoma were greater than that in ampullary carcinoma and duodenal papillary carcinoma.Conclusion MRI can prominently demonstrate various imaging characteristics of VPC with different histological origins.It is very valuable in the differential diagnosis of VPC with different histological types by comprehensive analysis of these findings.
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Periampullary carcinoma metastases are usually located at regional nodes, adjacent organs, liver or lung. On the other hand, metastatic penile cancer is uncommon. Penile metastasis usually originates from pelvic region with prostate and bladder being the most frequent primary location. We present a very rare case of periampullary carcinoma with penile metastasis in a 49-year-old man. He initially presented with early ampullary type periampullary carcinoma and had pyloric preserving pancreatoduodenectomy and adjuvant chemotherapy. However, after six years of uneventful follow up, he presented with a penile lesion which was confirmed to be pancreatic metastasis. He was started on chemotherapy but passed away two months later. Ampullary carcinoma type of periampullary carcinoma usually presents early with favourable prognosis. However, tumour recurrence can present much later after definitive treatment and at a rare site such as penis with generally poor outcome.
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The clinical data of 147 patients with carcinoma of ampulla of Vatar at our hospital from January 1998 to December 2012 were retrospectively analyzed.The neutrophil-to-lymphocyte ratio ( NLR) was calculated from pre-operative complete blood count.They were divided into low NLR group (NLR<5,n=121) and high NLR group (NLR≥5,n=26).The 5-year survival rates of two groups were compared and the prognostic risk factors examined by univariate analysis and Cox model.The 5-year free survival rates of low and high NLR groups were 57.9%and 27.6%respectively ( P=0.005 ).Univariate analysis revealed that depth of invasion (P=0.006),pancreatic invasion (P=0.002),lymph nodal metastasis (P=0.008), poor differentiation ( P =0.008 ) , tumor stage ( P =0.003 ) and per-operative NLR ( P =0.005 ) were significant prognostic factors.Multivariate analysis showed that per-operative NLR significantly increased the risk of recurrence (P<0.05).Pre-operative NLR represents a significant independent prognostic indicator for patients with carcinoma of ampulla of Vatar.
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Objective To investigate the value of modified pancreatoduodenectomy in the treatment of ampullary carcinoma by comparing the efficacy of pancreatoduodenectomy with preservation of ascending portion of duodenum and that of Whipple procedure. Methods The clinical data of 133 patients with ampullary carcinoma who had been admitted to the Qilu Hospital from 1990 to 2006 were retrospectively analyzed. Of the 133 patients, 88 received Whipple procedure (group A) and 45 received pancreatoduedenectomy with preservation of ascending portion of duodenum (group B). The preoperative condition of the patients and short- and long-term efficacy of the 2 procedures were compared by Fisher exact probability, t test, chi-square test, Kaplan-Meier survival curve and Log-rank test, and the differences between the efficacy of the 2 procedures were compared. Results The operation time, time of gastrointestinal function recovery, hospital stay and ratio of patients with blood transfusion were (366±111) minutes, (7.4±1.4) days, (24±9) days and 76% (67/88) in group A, and (325±32)minutes, (4.3±1.4)days, (31±14)days, 42% (19/45) in group B, with significant difference between the 2 groups (t = 2.34, 2.08, 1.98 ; χ2 = 14.99, P < 0.05). The medium survival time of patients in groups A and B were (19.0±1.5)months and (16.9±1.7) months, with no significant difference between the 2 groups (χ2 = 0.46, P > 0.05). There was no significant difference in the occurrence of postoperative complications between the 2 groups (P > 0.05). Conclusions Pancreateduodenectomy with preservation of ascending portion of duodenum can be applied for patients with ampullary carcinoma.
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PURPOSE: This retrospective study was aimed to determine prognostic factors after radical resection of an ampullary carcinoma. METHODS: Medical records of patients with adenocarcinoma of the ampulla of Vater who had undergone pancreaticoduodenectomy between Dec. 1994 and May 2002 were reviewed. This study included 59 men and 40 women with a mean age of 58.9 years. 62 patients underwent Whipple procedures, 36 patients, pylorus preserving pancreaticoduodenectomy and 1 patient, total pancreatectomy. Actuarial survival rates were calculated using the Kaplan-Meier method. A Cox proportional hazards model was used to test the independent predictors of survival. P<0.05 was considered statistically significant. RESULTS: The overall 5-year survival rate was 45.4% with 3% mortality and 34.3% morbidity. According to the pTNM stage, the 5-year survival rates were 91.7%, 54.3%, 28.5% and 0% at stages I, II, III, and IV (P<0.01), respectively. The patient survival was significantly impaired by the depth of invasion, lymph node metastasis and intraoperative transfusion (P<0.05). In a multivariate analysis, only lymph node metastasis was a statistically independent prognostic factor. CONCLUSION: pTNM stage is a good prognostic indicator for an ampullary carcinoma after pancreaticoduodenectomy and patients with lymph node metastasis should be identified as high risk and considered as candidates for further adjuvant therapy.
Subject(s)
Female , Humans , Male , Adenocarcinoma , Ampulla of Vater , Lymph Nodes , Medical Records , Mortality , Multivariate Analysis , Neoplasm Metastasis , Pancreatectomy , Pancreaticoduodenectomy , Proportional Hazards Models , Pylorus , Retrospective Studies , Survival RateABSTRACT
PURPOSE: To determine the clinical significance of p53, c-erbB-2, chromogranin A (CgA), proliferating cell nuclear antigen (PCNA) expression in ampullary carcinoma, a retrospective study was performed. MATERIALS AND METHODS: The cases of 96 patients who underwent curative resection for ampullary carcinoma during the ten-year period (1986-95) were reviewed. And, using paraffin-embedded tumor tissues, immunohistochemical (IHC) staining for p53, c-erbB-2, CgA, and PCNA was performed. RESULTS: The overall five-year survival rate (5-YSR) for these 96 patients was 58%. With regard to TNM stage, the 5-YSR was 71% for stage I (n=36), 62% for stage II (n=29), and 39% for stage III (n=31), respectively. IHC expression rate was 17.6% for c-erbB-2, 19.2% for CgA, and 42.9% for p53. The relative proportion of labelling index of PCNA (50%) was 30.8%, 25.3%, and 44.0%, respectively. The PCNA labelling index showedsignificant correlation with tumor size (p=0.032). The PCNA labelling index, c-erbB-2, CgA and p53 were not correlated to extent of invasion, lymph node metastasis, stage, or histologic type. CgA and c-erbB-2 expression and the PCNA labelling index thus had no prognostic value. With regard to p53, the 5-YSR of p53 negative cases was 68.6%; that of p53 positive cases was 47%, with significant difference (p=0.038). CONCLUSION: This result suggests that p53 expression is related to poor prognosis of ampullary carcinoma, and that c-erbB-2 and CgA expression, and the PCNA labelling index, are not significant prognostic factors.
Subject(s)
Humans , Chromogranin A , Genes, erbB-2 , Lymph Nodes , Neoplasm Metastasis , Prognosis , Proliferating Cell Nuclear Antigen , Retrospective Studies , Survival RateABSTRACT
The scraping procedure was adopted in 13 cases for diagnosis.of tumors of the ampulla vater. 11 of the 13 cases obtained tissue from distal common bile duct. Histological diagnoses included 9 adenocarcinoma, one adenoma with high atypical hyperplasia and carcinoma in situ,one villous papilomatous hyperplasia. No tissue obtained in two patients who were suspected to have ampullary carcinoma preoperatively. Adoptation of this method routinely during exploration of common bile duct would help diagnose the neglected carcinoma of ampulla vater. Most patients with malignancy of ampulla vater would obtain a positive result. However,a negative result could not rule out the diagnosis and other diagnostic tools should be used. If the tissues scraped were diagnosed as adenoma or villous tumor histologically, the malignant change might have been missed. Complete excision of the ampullary lesion is required to assess the presence or absence of malignancy accurately.