Management and outcomes following pancreaticoduodenectomy for ampullary adenocarcinoma.Chavez MT, Sharpe JP, O'Brien T, Patton KT, Portnoy DC, VanderWalde NA, Deneve JL, Shibata D, Behrman SW, Dickson PV. Am J Surg. 2017 Jan 30. [Epub ahead of print]

INTRODUCTION:The purpose of this study was to evaluate outcomes following pancreaticoduodenectomy(PD) for ampullary adenocarcinoma(AAC).

METHODS:We evaluated patients having undergone PD for AAC and the impact of clinical/histopathologic factors and adjuvant therapy(AT) on survival.RESULTS:52 patients underwent potentially curative PD. Perineural and lymphovascular invasion were associated with decreased survival. There was no difference in survival between patients treated with PD vs. PD+AT, however, AT was more often administered to patients with N1 vs. N0 and stage II/III vs. I disease. Among patients receiving AT, we observed a trend towards improved survival when radiation was included. Recurrence occurred in 7/18(39%) stage I patients, only 2(7%) of which received AT.CONCLUSION:AT did not improve survival, however was more commonly administered in advanced disease. Stage I patients had high recurrence rates but rarely received AT. Prospective evaluation of appropriate AT regimens and use in early stage patients should be considered.

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