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The role of local excision in invasive adenocarcinoma of the ampulla of Vater.

Publication ,  Journal Article
Zhong, J; Palta, M; Willett, CG; McCall, SJ; Bulusu, A; Tyler, DS; White, RR; Uronis, HE; Pappas, TN; Czito, BG
Published in: J Gastrointest Oncol
March 2013

BACKGROUND: Ampulla of Vater carcinomas are rare malignancies that have been traditionally treated with radical surgical resection. Given the mortality associated with pancreaticoduodenectomy, some patients may benefit from local resection. A single-institution outcomes analysis was performed to define the role of local resection. METHODS: Patients undergoing local resection (ampullectomy) for ampullary carcinomas at Duke University between 1976 and 2010 were analyzed retrospectively. Time-to-event analysis was conducted analyzing all patients undergoing surgery, with and without adjuvant chemoradiation therapy (CRT). Overall survival (OS), local control (LC), metastases-free survival (MFS), and disease-free survival (DFS) were studied using Kaplan-Meier analysis. RESULTS: A total of 17 patients with invasive carcinoma underwent ampullectomy. The 3-and 5-year LC, MFS, DFS and OS rates were 36% and 24%, 68% and 54%, 31% and 21%, and 35% and 21%, respectively. Patients receiving adjuvant CRT did not appear to have improved outcomes compared with surgery alone, although this group tended to have poorer histological grade, more advanced tumor staging and involved surgical margins. CONCLUSIONS: Ampullectomy for invasive ampullary adenocarcinomas is a safe procedure but does not offer satisfactory long-term results, mostly due to high local failure rates. Adjuvant CRT therapy does not appear to offer increased local control or survival benefit following ampullectomy, although these results may suffer from selection bias and small sample size. Local resection should be limited to benign ampullary lesions or patients with very small, early tumors with favorable histologic features where radical resection is not feasible.

Duke Scholars

Published In

J Gastrointest Oncol

DOI

ISSN

2078-6891

Publication Date

March 2013

Volume

4

Issue

1

Start / End Page

8 / 13

Location

China

Related Subject Headings

  • 3211 Oncology and carcinogenesis
  • 3202 Clinical sciences
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Zhong, J., Palta, M., Willett, C. G., McCall, S. J., Bulusu, A., Tyler, D. S., … Czito, B. G. (2013). The role of local excision in invasive adenocarcinoma of the ampulla of Vater. J Gastrointest Oncol, 4(1), 8–13. https://doi.org/10.3978/j.issn.2078-6891.2012.055
Zhong, Jim, Manisha Palta, Christopher G. Willett, Shannon J. McCall, Anuradha Bulusu, Douglas S. Tyler, Rebekah R. White, Hope E. Uronis, Theodore N. Pappas, and Brian G. Czito. “The role of local excision in invasive adenocarcinoma of the ampulla of Vater.J Gastrointest Oncol 4, no. 1 (March 2013): 8–13. https://doi.org/10.3978/j.issn.2078-6891.2012.055.
Zhong J, Palta M, Willett CG, McCall SJ, Bulusu A, Tyler DS, et al. The role of local excision in invasive adenocarcinoma of the ampulla of Vater. J Gastrointest Oncol. 2013 Mar;4(1):8–13.
Zhong, Jim, et al. “The role of local excision in invasive adenocarcinoma of the ampulla of Vater.J Gastrointest Oncol, vol. 4, no. 1, Mar. 2013, pp. 8–13. Pubmed, doi:10.3978/j.issn.2078-6891.2012.055.
Zhong J, Palta M, Willett CG, McCall SJ, Bulusu A, Tyler DS, White RR, Uronis HE, Pappas TN, Czito BG. The role of local excision in invasive adenocarcinoma of the ampulla of Vater. J Gastrointest Oncol. 2013 Mar;4(1):8–13.

Published In

J Gastrointest Oncol

DOI

ISSN

2078-6891

Publication Date

March 2013

Volume

4

Issue

1

Start / End Page

8 / 13

Location

China

Related Subject Headings

  • 3211 Oncology and carcinogenesis
  • 3202 Clinical sciences