Postoperative recurrence and metastasis in patients of the ampulla of Vater adenocarcimona / 中华普通外科杂志

ABSTRACT

Objective To identify the pmgnesfic factors influencing the recurrence and metastasis of adenocarcinoma of the ampulla of Vater after panreaticoduodenectomy. Methods A retrospective study was carried out on the clinical manifestation, pathological behavior and survival data in 101 patients with Vater's ampullary adenecarcinoma receiving pancreaticoduodenectomy from Jan 1980 to Dec 2003. Results According to TNM system, there were 42 cases (41.6%) of stage Ⅰ, 32 cases (31.7%) of stage Ⅱ, 27 cases (26.7%) of stage Ⅲ. During postoperative follow-up period [ median, 46(2-192) months] 25 patients (24.8%) suffered from recurrence or/and metastasis with the median recurrence time of 20 (2-93) months, among which there were 11(10.8%) cases of local recurrence and 20 (19.6%) cases of distant metastasis. The differences were statistically significant between the patients with recurrence or/and metastasis and those without in the following parameters tumor size larger than 2 cm (64% vs. 39%, X2=4.56, P=0.033), positive lymph node metastasis in the primary specimens (52% vs. 17%, X2=11.98, P=0.001), postoperative complications (51% vs. 20%, X2=7.50, P=0.006). Logistic regression showed only lymph node status (OR=5.14, P=0.0037) was independent factors of tumor recurrence and metastasis. The median non-recurrent time in those without lymph node metastasis was 49 (2-192) months, significantly longer than the median 32(12-152) months in those with metastasis (X2=5.43, P=0.0198, log-rank test). Conclusions Recurrent metastasis is the main problem in patients with ampullary adenocarcinoma after pancreaticoduodenectomy. The lymph node status is an independent prognostic factor.