Clinicopathologic analysis of XXXX in 450 @entity1 : implications for surgical strategy and long-term prognosis.

@entity1 @entity2558 @entity5 @entity27894 @entity3 @entity3122 @entity652 @entity420
BACKGROUND: Whether @entity5 are best surgically managed by pancreaticoduodenectomy versus local ampullectomy is controversial. We sought to examine the outcome of @entity1 undergoing pancreaticoduodenectomy versus ampullectomy, as well as to identify factors predictive of lymph node @entity3 in @entity1 with @entity5 . METHODS: Between 1970 and 2007, 450 @entity1 who underwent surgical resection of ampullary @entity652 or @entity420 were identified from a prospective, single-institution database. Data on clinicopathologic factors, morbidity, mortality, and survival were analyzed. RESULTS: The initial surgical procedure was pancreaticoduodenectomy in 96.7% @entity1 and ampullectomy in 3.3%. Final diagnosis was invasive @entity420 (77.1%) or @entity652 (22.9%). Median @entity5 size was similar for @entity652 associated with an @entity420 (2.5 cm) versus @entity652 without @entity3 (2.9 cm; P=0.71). Morbidity was comparable with pancreaticoduodenectomy (52.2%) versus ampullectomy (33.3%; P=0.15), as was 30-day mortality (pancreaticoduodenectomy, 2.1% versus ampullectomy, 0%; P=0.6). @entity3 to regional lymph nodes was present in 54.5% @entity1 with @entity420 . Factors associated with presence of lymph node @entity3 included @entity5 size > or = 1 cm ( @entity3122 ), poor histologicgrade (OR 4.8), perineural invasion (OR 3.0), microscopic vessel invasion ( @entity27894 ), and depth of invasion > @entity2558 (OR 4.3; all P<0.05). Specifically, risk of lymph node @entity3 increased with T stage (T1, 28.0%; T2, 50.9%; T3, 71.7%; T4, 77.3%; P<0.001). CONCLUSION: When surgery is indicated, radical resection is required for early invasive @entity420 of the ampulla of Vater, as lymph node @entity3 are present in nearly 30% of @entity1 with T1 disease. Pancreaticoduodenectomy should be the preferred approach for most @entity5 that require surgical resection.
