Recurrent disease after microscopically radical (R0) resection of periampullary adenocarcinoma in patients without adjuvant therapy

Steve M M De Castro, Koert F D Kuhlmann, N. Tjarda Van Heek, Olivier R C Busch, G. Johan Offerhaus, Thomas M. Van Gulik, Hugo Obertop, Dirk J. Gouma, M. Sarr, J. Kral

Research output: Contribution to journalArticle

Abstract

The survival rate after microscopically radical resection of pancreatic duct adenocarcinoma is still poor. Patients with ampulla of Vater and distal common bile duct adenocarcinoma indicate a much more favorable prognosis. Controversy exists as to whether adjuvant therapy could improve the outcome in these patients after resection. The aim of the present study was to analyze the pattern of recurrence in patients with periampullary adenocarcinoma after pancreatoduodenectomy. Between January 1992 and December 2002, all patients with an R0 resection were identified and used for this analysis. A total of 190 patients underwent a microscopically radical resection and received no adjuvant therapy. Of those, 72 patients were diagnosed with pancreatic duct adenocarcinoma, 86 patients were diagnosed with ampulla of Vater adenocarcinoma, and 31 patients were diagnosed with distal common bile duct adenocarcinoma. Recurrent disease was indicated in 81% of the patients with pancreatic duct adenocarcinoma, 50% of the patients with ampulla of Vater adenocarcinoma, and in 74% of the patients with bile duct adenocarcinoma. Multivariate analysis revealed that lymph node metastases were prognostic for recurrent disease in patients with pancreatic duct adenocarcinoma (P = 0.038). The depth of invasion (T4, P <0.032) and lymph node metastases (P <0.001) were prognostic in patients with ampulla of Vater adenocarcinoma. Poor tumor differentiation (P <0.001) was prognostic in patients with distal bile duct adenocarcinoma. Selected patients with periampullary malignancies exhibited a high recurrence rate and should be encouraged to enroll in clinical trials for adjuvant treatment including local therapy (radiotherapy) according to the identified prognostic factors.

Original languageEnglish (US)
Pages (from-to)775-784
Number of pages10
JournalJournal of Gastrointestinal Surgery
Volume8
Issue number7
DOIs
StatePublished - 2004
Externally publishedYes

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Adenocarcinoma
Ampulla of Vater
Pancreatic Ducts
Therapeutics
Common Bile Duct
Bile Ducts
Lymph Nodes
Neoplasm Metastasis
Recurrence
Pancreaticoduodenectomy
Neoplasms
Radiotherapy
Multivariate Analysis
Survival Rate
Clinical Trials

Keywords

  • Adjuvant
  • Ampulla of Vater
  • Bile duct neoplasms
  • Carcinoma
  • Chemotherapy
  • Pancreatic ductile
  • Radiotherapy

ASJC Scopus subject areas

  • Surgery

Cite this

De Castro, S. M. M., Kuhlmann, K. F. D., Van Heek, N. T., Busch, O. R. C., Offerhaus, G. J., Van Gulik, T. M., ... Kral, J. (2004). Recurrent disease after microscopically radical (R0) resection of periampullary adenocarcinoma in patients without adjuvant therapy. Journal of Gastrointestinal Surgery, 8(7), 775-784. https://doi.org/10.1016/j.gassur.2004.08.006

Recurrent disease after microscopically radical (R0) resection of periampullary adenocarcinoma in patients without adjuvant therapy. / De Castro, Steve M M; Kuhlmann, Koert F D; Van Heek, N. Tjarda; Busch, Olivier R C; Offerhaus, G. Johan; Van Gulik, Thomas M.; Obertop, Hugo; Gouma, Dirk J.; Sarr, M.; Kral, J.

In: Journal of Gastrointestinal Surgery, Vol. 8, No. 7, 2004, p. 775-784.

Research output: Contribution to journalArticle

De Castro, SMM, Kuhlmann, KFD, Van Heek, NT, Busch, ORC, Offerhaus, GJ, Van Gulik, TM, Obertop, H, Gouma, DJ, Sarr, M & Kral, J 2004, 'Recurrent disease after microscopically radical (R0) resection of periampullary adenocarcinoma in patients without adjuvant therapy', Journal of Gastrointestinal Surgery, vol. 8, no. 7, pp. 775-784. https://doi.org/10.1016/j.gassur.2004.08.006
De Castro, Steve M M ; Kuhlmann, Koert F D ; Van Heek, N. Tjarda ; Busch, Olivier R C ; Offerhaus, G. Johan ; Van Gulik, Thomas M. ; Obertop, Hugo ; Gouma, Dirk J. ; Sarr, M. ; Kral, J. / Recurrent disease after microscopically radical (R0) resection of periampullary adenocarcinoma in patients without adjuvant therapy. In: Journal of Gastrointestinal Surgery. 2004 ; Vol. 8, No. 7. pp. 775-784.
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abstract = "The survival rate after microscopically radical resection of pancreatic duct adenocarcinoma is still poor. Patients with ampulla of Vater and distal common bile duct adenocarcinoma indicate a much more favorable prognosis. Controversy exists as to whether adjuvant therapy could improve the outcome in these patients after resection. The aim of the present study was to analyze the pattern of recurrence in patients with periampullary adenocarcinoma after pancreatoduodenectomy. Between January 1992 and December 2002, all patients with an R0 resection were identified and used for this analysis. A total of 190 patients underwent a microscopically radical resection and received no adjuvant therapy. Of those, 72 patients were diagnosed with pancreatic duct adenocarcinoma, 86 patients were diagnosed with ampulla of Vater adenocarcinoma, and 31 patients were diagnosed with distal common bile duct adenocarcinoma. Recurrent disease was indicated in 81{\%} of the patients with pancreatic duct adenocarcinoma, 50{\%} of the patients with ampulla of Vater adenocarcinoma, and in 74{\%} of the patients with bile duct adenocarcinoma. Multivariate analysis revealed that lymph node metastases were prognostic for recurrent disease in patients with pancreatic duct adenocarcinoma (P = 0.038). The depth of invasion (T4, P <0.032) and lymph node metastases (P <0.001) were prognostic in patients with ampulla of Vater adenocarcinoma. Poor tumor differentiation (P <0.001) was prognostic in patients with distal bile duct adenocarcinoma. Selected patients with periampullary malignancies exhibited a high recurrence rate and should be encouraged to enroll in clinical trials for adjuvant treatment including local therapy (radiotherapy) according to the identified prognostic factors.",
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AU - Kuhlmann, Koert F D

AU - Van Heek, N. Tjarda

AU - Busch, Olivier R C

AU - Offerhaus, G. Johan

AU - Van Gulik, Thomas M.

AU - Obertop, Hugo

AU - Gouma, Dirk J.

AU - Sarr, M.

AU - Kral, J.

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