The importance of choice of resection procedures in T1 and T2 stage of XXXX of the ampulla of Vater.

@entity1 @entity2558 @entity1803 @entity5 @entity189 @entity260 @entity3121
PURPOSE: The ampulla of Vater (AV), with its strategic location and its remarkable predisposition to the development of various @entity5 , makes it very challenging for surgery. In this study we aimed to examine the prognostic factors in the treatment of early-stage @entity189 of the AV as well as to contribute to the choice of optimal surgical procedure. METHODS: We analyzed 109 AV @entity1 , hospitalized at the Clinical Center of Serbia from January 1999 to December 2008 and we compared the clinicopathological features, analyzed intra- and postoperative data, recurrences and survival, according to duodenopancreatectomy (DP) or local resection (LR). RESULTS: DP was performed in 83 and LR in 26 @entity1 . Overall survival (OS) was significantly influenced by the pathological (p) @entity5 stage ( @entity2558 /T2 vs @entity1803 /T4), pathological nodal stage (pN0 vs @entity3121 ), perineural and vascular invasion, grade of @entity5 differentiation (G1 vs G3), and resection margin status (R0 vs R1). Kaplan-Meier analysis showed 64% 5-year overall survival of @entity1 with @entity2558 /T2 stage in the group with DP, and 58% in the group with LR (p>0.05). Survival analysis of @entity3121 @entity1 in these two groups showed statistically significant difference (DP 49.67 vs LR 28.68 months, p<0.05). @entity260 occurred more frequently in @entity1 treated with DP, compared with LR. @entity5 recurrence occurred in 23.07% of LR @entity1 and in 4.0% of DP @entity1 , in @entity2558 /T2 stage. The rate of in-hospital mortality was not significantly different in DP (9.78%) vs LR (0%) @entity1 (p>0.05). CONCLUSION: Resection is mandatory for all proven AV @entity5 , and DP is the treatment choice. LR, due to reduced morbidity and mortality, might be recommended in elderly @entity1 with comorbidities and in @entity1 with stage @entity2558 /T2, pN0 and well differentiated (G1,G2) @entity5 .
