Influence of Preoperative Therapy on Short- and Long-Term Outcomes of Patients with Adenocarcinoma of the Ampulla of Vater

Jordan M. Cloyd, Huamin Wang, Michael Overman, Jun Zhao, Jason Denbo, Laura Prakash, Michael P. Kim, Rachna Shroff, Milind Javle, Gauri R. Varadhachary, David Fogelman, Robert A. Wolff, Eugene J. Koay, Prajnan Das, Anirban Maitra, Thomas A. Aloia, Jean Nicolas Vauthey, Jason B. Fleming, Jeffrey E. Lee, Matthew H G Katz

Research output: Contribution to journalArticle

Abstract

Introduction: Although preoperative therapy is increasingly administered to patients with pancreatic adenocarcinoma, the role of preoperative therapy for patients with adenocarcinoma of the ampulla of Vater is undefined. Methods: All patients with ampullary cancer who were evaluated between 1999 and 2014 were retrospectively reviewed. Differences in clinicopathologic characteristics, perioperative complications, and overall survival were compared between patients who underwent surgery de novo and those who received preoperative therapy before pancreatoduodenectomy. Results: A total of 142 patients underwent pancreatoduodenectomy: 43 (30.3%) who received preoperative therapy and 99 (69.7%) who did not. Preoperative therapy consisted of chemoradiation (65%), chemotherapy (7%), or both (28%). Patients who underwent surgery first had a lower comorbidity index (p < 0.05) and were more likely to receive postoperative chemotherapy (p < 0.01) and chemoradiation (p < 0.0001). Tumors resected de novo were larger (p < 0.01) and had a different histopathologic subtype distribution (p < 0.01) on final pathology than those resected following preoperative therapy. Six (14.0%) patients demonstrated a complete pathologic response. There were no differences in rates of postoperative complications, mortality, readmission, LR (9.1 vs. 7.0%), median survival (107 vs. 146 months), or 5-year overall survival (60.6 vs. 70.4%). On multivariate cox regression analysis, the receipt of preoperative therapy was not associated with improved survival (odds ratio 1.14, 95% confidence interval (CI) 0.56–2.31). Conclusions: Although these data do not support the routine administration of preoperative therapy to all patients with ampullary cancer, the delivery of preoperative therapy represents an alternative strategy that is associated with excellent short- and long-term outcomes and appears appropriate for a subset of patients.

Original languageEnglish (US)
Pages (from-to)1-9
Number of pages9
JournalAnnals of Surgical Oncology
DOIs
StateAccepted/In press - Jan 25 2017
Externally publishedYes

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Ampulla of Vater
Adenocarcinoma
Pancreaticoduodenectomy
Therapeutics
Survival
Drug Therapy
Neoplasms
Complementary Therapies
Comorbidity
Odds Ratio
Regression Analysis
Confidence Intervals
Pathology

ASJC Scopus subject areas

  • Surgery
  • Oncology

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Influence of Preoperative Therapy on Short- and Long-Term Outcomes of Patients with Adenocarcinoma of the Ampulla of Vater. / Cloyd, Jordan M.; Wang, Huamin; Overman, Michael; Zhao, Jun; Denbo, Jason; Prakash, Laura; Kim, Michael P.; Shroff, Rachna; Javle, Milind; Varadhachary, Gauri R.; Fogelman, David; Wolff, Robert A.; Koay, Eugene J.; Das, Prajnan; Maitra, Anirban; Aloia, Thomas A.; Vauthey, Jean Nicolas; Fleming, Jason B.; Lee, Jeffrey E.; Katz, Matthew H G.

In: Annals of Surgical Oncology, 25.01.2017, p. 1-9.

Research output: Contribution to journalArticle

Cloyd, JM, Wang, H, Overman, M, Zhao, J, Denbo, J, Prakash, L, Kim, MP, Shroff, R, Javle, M, Varadhachary, GR, Fogelman, D, Wolff, RA, Koay, EJ, Das, P, Maitra, A, Aloia, TA, Vauthey, JN, Fleming, JB, Lee, JE & Katz, MHG 2017, 'Influence of Preoperative Therapy on Short- and Long-Term Outcomes of Patients with Adenocarcinoma of the Ampulla of Vater', Annals of Surgical Oncology, pp. 1-9. https://doi.org/10.1245/s10434-017-5777-7
Cloyd, Jordan M. ; Wang, Huamin ; Overman, Michael ; Zhao, Jun ; Denbo, Jason ; Prakash, Laura ; Kim, Michael P. ; Shroff, Rachna ; Javle, Milind ; Varadhachary, Gauri R. ; Fogelman, David ; Wolff, Robert A. ; Koay, Eugene J. ; Das, Prajnan ; Maitra, Anirban ; Aloia, Thomas A. ; Vauthey, Jean Nicolas ; Fleming, Jason B. ; Lee, Jeffrey E. ; Katz, Matthew H G. / Influence of Preoperative Therapy on Short- and Long-Term Outcomes of Patients with Adenocarcinoma of the Ampulla of Vater. In: Annals of Surgical Oncology. 2017 ; pp. 1-9.
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title = "Influence of Preoperative Therapy on Short- and Long-Term Outcomes of Patients with Adenocarcinoma of the Ampulla of Vater",
abstract = "Introduction: Although preoperative therapy is increasingly administered to patients with pancreatic adenocarcinoma, the role of preoperative therapy for patients with adenocarcinoma of the ampulla of Vater is undefined. Methods: All patients with ampullary cancer who were evaluated between 1999 and 2014 were retrospectively reviewed. Differences in clinicopathologic characteristics, perioperative complications, and overall survival were compared between patients who underwent surgery de novo and those who received preoperative therapy before pancreatoduodenectomy. Results: A total of 142 patients underwent pancreatoduodenectomy: 43 (30.3{\%}) who received preoperative therapy and 99 (69.7{\%}) who did not. Preoperative therapy consisted of chemoradiation (65{\%}), chemotherapy (7{\%}), or both (28{\%}). Patients who underwent surgery first had a lower comorbidity index (p < 0.05) and were more likely to receive postoperative chemotherapy (p < 0.01) and chemoradiation (p < 0.0001). Tumors resected de novo were larger (p < 0.01) and had a different histopathologic subtype distribution (p < 0.01) on final pathology than those resected following preoperative therapy. Six (14.0{\%}) patients demonstrated a complete pathologic response. There were no differences in rates of postoperative complications, mortality, readmission, LR (9.1 vs. 7.0{\%}), median survival (107 vs. 146 months), or 5-year overall survival (60.6 vs. 70.4{\%}). On multivariate cox regression analysis, the receipt of preoperative therapy was not associated with improved survival (odds ratio 1.14, 95{\%} confidence interval (CI) 0.56–2.31). Conclusions: Although these data do not support the routine administration of preoperative therapy to all patients with ampullary cancer, the delivery of preoperative therapy represents an alternative strategy that is associated with excellent short- and long-term outcomes and appears appropriate for a subset of patients.",
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T1 - Influence of Preoperative Therapy on Short- and Long-Term Outcomes of Patients with Adenocarcinoma of the Ampulla of Vater

AU - Cloyd, Jordan M.

AU - Wang, Huamin

AU - Overman, Michael

AU - Zhao, Jun

AU - Denbo, Jason

AU - Prakash, Laura

AU - Kim, Michael P.

AU - Shroff, Rachna

AU - Javle, Milind

AU - Varadhachary, Gauri R.

AU - Fogelman, David

AU - Wolff, Robert A.

AU - Koay, Eugene J.

AU - Das, Prajnan

AU - Maitra, Anirban

AU - Aloia, Thomas A.

AU - Vauthey, Jean Nicolas

AU - Fleming, Jason B.

AU - Lee, Jeffrey E.

AU - Katz, Matthew H G

PY - 2017/1/25

Y1 - 2017/1/25

N2 - Introduction: Although preoperative therapy is increasingly administered to patients with pancreatic adenocarcinoma, the role of preoperative therapy for patients with adenocarcinoma of the ampulla of Vater is undefined. Methods: All patients with ampullary cancer who were evaluated between 1999 and 2014 were retrospectively reviewed. Differences in clinicopathologic characteristics, perioperative complications, and overall survival were compared between patients who underwent surgery de novo and those who received preoperative therapy before pancreatoduodenectomy. Results: A total of 142 patients underwent pancreatoduodenectomy: 43 (30.3%) who received preoperative therapy and 99 (69.7%) who did not. Preoperative therapy consisted of chemoradiation (65%), chemotherapy (7%), or both (28%). Patients who underwent surgery first had a lower comorbidity index (p < 0.05) and were more likely to receive postoperative chemotherapy (p < 0.01) and chemoradiation (p < 0.0001). Tumors resected de novo were larger (p < 0.01) and had a different histopathologic subtype distribution (p < 0.01) on final pathology than those resected following preoperative therapy. Six (14.0%) patients demonstrated a complete pathologic response. There were no differences in rates of postoperative complications, mortality, readmission, LR (9.1 vs. 7.0%), median survival (107 vs. 146 months), or 5-year overall survival (60.6 vs. 70.4%). On multivariate cox regression analysis, the receipt of preoperative therapy was not associated with improved survival (odds ratio 1.14, 95% confidence interval (CI) 0.56–2.31). Conclusions: Although these data do not support the routine administration of preoperative therapy to all patients with ampullary cancer, the delivery of preoperative therapy represents an alternative strategy that is associated with excellent short- and long-term outcomes and appears appropriate for a subset of patients.

AB - Introduction: Although preoperative therapy is increasingly administered to patients with pancreatic adenocarcinoma, the role of preoperative therapy for patients with adenocarcinoma of the ampulla of Vater is undefined. Methods: All patients with ampullary cancer who were evaluated between 1999 and 2014 were retrospectively reviewed. Differences in clinicopathologic characteristics, perioperative complications, and overall survival were compared between patients who underwent surgery de novo and those who received preoperative therapy before pancreatoduodenectomy. Results: A total of 142 patients underwent pancreatoduodenectomy: 43 (30.3%) who received preoperative therapy and 99 (69.7%) who did not. Preoperative therapy consisted of chemoradiation (65%), chemotherapy (7%), or both (28%). Patients who underwent surgery first had a lower comorbidity index (p < 0.05) and were more likely to receive postoperative chemotherapy (p < 0.01) and chemoradiation (p < 0.0001). Tumors resected de novo were larger (p < 0.01) and had a different histopathologic subtype distribution (p < 0.01) on final pathology than those resected following preoperative therapy. Six (14.0%) patients demonstrated a complete pathologic response. There were no differences in rates of postoperative complications, mortality, readmission, LR (9.1 vs. 7.0%), median survival (107 vs. 146 months), or 5-year overall survival (60.6 vs. 70.4%). On multivariate cox regression analysis, the receipt of preoperative therapy was not associated with improved survival (odds ratio 1.14, 95% confidence interval (CI) 0.56–2.31). Conclusions: Although these data do not support the routine administration of preoperative therapy to all patients with ampullary cancer, the delivery of preoperative therapy represents an alternative strategy that is associated with excellent short- and long-term outcomes and appears appropriate for a subset of patients.

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