T. Ochiai1, T. Miura2, S. Tanaka1, S. Yamazaki2, A. Kudo1, N. Noguchi2, T. Irie2, D. Ban1, A. Aihara1, S. Matsumura1, Y. Mitsunori1, H. Ito1, K. Akahoshi1, M. Tanabe1 1Tokyo Medical And Dental University,Bunkyo-ku, Tokyo, Japan 2Ohta Nishinouchi General Hospital,Koriyama, FUKUSHIMA, Japan
Introduction:
Pancreatoduodenectomy was the standard treatment for ampullary carcinoma, regardless of staging, previously. With recent advances of diagnostic modalities, accuracy of preoperative staging of ampullary neoplasm has been improved, therefore, limited resection of early ampulla of Vater carcinoma has been performed such as; endoscopic papillectomy and transduodenal papillectomy. In this study, we studied consecutive 65 cases of pancreatectoduodenectomy and analyzed tumor staging and prognosis.
Methods:
From January 2000 to December 2014, consecutive 65 patients with carcinoma of the papilla of Vater underwent pancreatoduodenectomy (PD), pylorus preserving pancreatoduodenectomy (PPPD), substomach preserving pancreatoduodenectomy (SSPPD) or total pancreatecomy (TP) with dissection of regional lymph nodes in Tokyo Medical and Dental University Hospital (28 cases)and Ohta Nishinouchi General Hospital (37 cases). We retrospectively analyzed surgical procedures, macroscopic and microscopic curability, clinicopathologic variables and survival.
Results:
A total of 65 patients underwent PD, PPPD, SSPPD or TP, aged 44 to 88 years and consisted of 40 males and 25 females. The surgical procedure was PD in 28 case (43.1%), PPPD in 26 (40.0%), SSPPD in 10 (15.4%) and TP in 1 (1.5%). Patients were grouped according to UICC TNM-staging as stage IA (n=14, 21.5%), stage IB (n=12, 18.5%), stage IIA (n=10, 15.4%), stage IIB (n=22, 33.8%), stage III (n=4, 6.2%), or stage IV (n=3, 4.6%). The overall and disease-free 1-, 3-, 5-, 10- year survival rates were 91.4%, 70.9%, 50.9%, 48.1% and 81.5%, 59.7%, 48.7%, 42.9% respectively. In univariate analysis, age, the depth of tumor infiltration, lymph node involvement, differentiation, stage, curability and operative procedures were significantly different. In multivariate analysis, age (OR 1.08), lymph node metastases (OR 4.02), curability (OR 5.91) were significantly different in prognosis. Metastatic disease to regional lymph nodes was present in 41.5% patients. Moreover, 4 out of 11 (36.4%), with invasion to the sphincter of Oddi in pT1, revealed lymph node metastases.
Conclusion:
Although accuracy of preoperative staging of ampullary neoplasm has been improved, evaluation of minimal invasion of the Oddi’s sphincter is considered still difficult in general. As 36.4 % cases of invasion to the sphincter of Oddi in pT1 revealed lymph node involvement, pancreatoduodenectomy with lymphadenectomy should be required for cancer patients.