Patterns and predictors of failure after curative resections of XXXX of the ampulla of Vater.

@entity1 @entity5 @entity1735 @entity189 @entity3
BACKGROUND: Curative resection does not always equate with long-term survival. The aim was to identify patterns and predictors of failure and independent factors of prognosis after curative resection. METHODS: Sixty-six @entity1 with @entity189 who underwent surgical intervention were reviewed. Fifty-nine @entity1 underwent pancreaticoduodenectomy. Cox regression analysis, log-rank test, Fisher exact test, or chi(2) test was used. RESULTS: No @entity1 died as a result of surgery; major complications occurred in three, and the 5-year survival rate after curative resection (n = 55) was 52.6%. Significant survival predictors were preoperative serum carcinoembryonic antigen level; gross @entity5 appearance; @entity5 , node, and @entity5 node @entity3 stage; and microscopic lymphatic vessel and venous invasion in the @entity5 . Multivariate analysis demonstrated that lymphatic vessel invasion, @entity5 , and @entity5 node @entity3 stage were significant independent prognostic factors. No @entity1 experienced locoregional failure alone; all 24 relapsed @entity1 had distant failure, and six of them had both. The liver was the most frequent metastatic organ, followed by nodes, peritoneum, lung, and bone. The carcinoembryonic antigen and @entity1735 antigen levels and lymphatic vessel and venous invasion were significant predictors of distant failure, and the mean time to relapse was 13 (range, 0.7-33) months. CONCLUSIONS: Curative resection is associated with significant survival; however, effective systemic adjuvant therapy is needed to prevent distant failure for @entity1 with elevated carcinoembryonic antigen and @entity1735 antigen levels or positive lymphatic vessel or venous invasion. A 3-year follow-up period would be necessary to document relapses.
