Results of cephalic pancreaticoduodenectomy for ampullary carcinoma. Analysis of 18 consecutive cases

Complete resection offers the only potential cure for ampullary carcinoma. The aim of this study was to assess the results of cephalic pancreaticoduodenectomy for patients with ampullary carcinoma based on mortality, hospital morbidity, late morbidity, and survival. Nodal status was specially analized in an attempt to identify patients who are at high risk for recurrence. We retrospectively and prospectively reviewed all patients who underwent cephalic pancreaticoduodenectomy, between October 1994 and October 2006 for ampullary carcinoma. Demographic, clinical and pathological data were collected. To evaluate survival, Kaplan-Meier analyses were compared in patients with and without nodal disease using the long-rank test. Cephalic pancreaticoduodenec- tomy was performed in 18 of 20 patients (resectability rate: 90%), with zero mortality and a thirty-day morbidity of 44.4% (8 patients). The tumor was unresectable in the remaining 2 patients. The mean age of the 18 patients (11 males and 7 females) was 55.7% years (range: 34-76 years). Jaundice (n = 17) and weight loss (n = 15) were the most common presenting symptoms. Mean operative time was 5.7 hours (range: 4-8 hours), and mean estimated blood loss was 400 mL (range: 400-800 mL). Resection margins were tumor free (RO) in all patients. Nine patients (50%) had node positive disease (stage IIB, AJCC). Median follow-up for patients still alive was 22 months (range: 2-86 months). The overall 5-year survival was 31%. This survival was significantly influenced by the presence lymph node metastases (N1): 60% in node-negative patients compared with 0% in node-positive patients (P = 0.0257). Cephalic pancreaticoduodenectomy is the surgical procedure of choice for ampullary carcinoma, with low hospital mortality, and the best chance for cure in patients with node-negative disease.