Carcinoma of the ampulla of Vater: Prognostic factors after curative surgery: A series of 45 cases

Background-Some adjuvant or neo-adjuvant therapy could be important for patients operated on for tumours of the ampulla of Vater, especially for those having a higher risk of recurrence. Aim-To evaluate prognostic factors after curative surgery based on a series of 45 cases of malignant tumours of the Oddi sphincter. Patients-From 1970 to 1992, a curative resection was performed in 45 patients (age 62 . 8 (SD 10 . 1) years) with adenocarcinoma of the ampulla. Surgical procedures included pancreatoduodenectomy (n=42) and resection of the ampulla (n=3). Actuarial survival was 44 (SD 9)% at five years. Methods-Various prognostic variables were studied: clinical manifestations, macroscopic aspect, differentiation, noninvasive adenomatous component, mucin histochemistry, immunohistochemistry (CEA, CA19.9, p53, Ki67), and accepted classifications (Blumgart and Kennedy, Martin, Yamaguchi and Enjoji, Talbot et al, pTNM). Results-Variables with prognostic power, in order of importance were: Classification of Talbot ef al; CA19.9; pTNM; sialomucins; classification of Yamaguchi and Ejoji; Martin classification; sulphomucins; non-invasive adenomatous component (positive>negative); jaundice; tumour localisation. Conclusions-This series confirmed the prognostic power of former classifications and showed the prognostic power of other variables (mucin, non-invasive adenomatous component, CA19.9).