Recent experience with XXXX of the ampulla of Vater in a national hospital group.

@entity1 @entity295 @entity548 @entity55 @entity5 @entity189 @entity3472
A total of 64 resections, 24 operative bypasses and 35 nonoperative biliary intubations, were performed for @entity189 in U.S. Dept. of Veterans Affairs hospitals from 1987 to 1991. Mean survival after resection was 702 days, significantly higher (ANOVA, P < or = 0.005) than that after bypass (345 days) or intubation (385 days). Operative mortality rates were similar: resection or intubation = 14%, bypass = 12%. Operative (30-day) mortality was zero in four local resections, 10% in 51 Whipples and 44% in nine total pancreatectomies. TNM staging was available for 74 @entity1 , and mean survival after resection exceeded 2 years in 34 @entity1 with Stage I-II (localized) @entity5 , was 532 days in 10 @entity1 with Stage III (regional nodes +) and 77 days in two @entity1 with Stage IV (metastatic) disease. However, mean survival without resection was 498 days in 14 @entity1 with @entity5 , 634 days in two @entity1 with regional and 215 days in 11 @entity1 with distant metastases. Resection clearly increased survival only for @entity5 (P < or = 0.02). Predicted 5-year survival rates by stage after resection were: I-II = 21%, III < 10%, IV = 0%. Complications were recorded in 29 per cent of resected @entity1 , with @entity295 the most common (21% of resections). Both @entity295 and @entity548 significantly decreased mean survival (P < or = 0.05, ANOVA), but @entity55 , @entity3472 , or wound problems did not. @entity5 is a favorable subtype of @entity5 , but prolonged survival is also seen without resection and may be largely limited to @entity5 that do not involve regional nodes.
