Safety and efficacy of curative intent surgery for peri-ampullary liver metastasis

Mechteld C. De Jong, Susan Tsai, John L. Cameron, Christopher L. Wolfgang, Kenzo Hirose, Mark G. Van Vledder, Frederic Eckhauser, Joseph M. Herman, Barish H. Edil, Michael A. Choti, Richard D. Schulick, Timothy M. Pawlik

Research output: Contribution to journalArticle

Abstract

Introduction: The management of patients with peri-ampullary liver metastasis remains controversial.We sought to assess the safety and efficacy of curative intent surgery for peri-ampullary liver metastasis. Methods: Between 1993 and 2009, 40 patients underwent curative intent surgery (resection and/or radiofrequency ablation (RFA)) for periampullary liver metastasis. Clinicopathologic and outcome data were collected and analyzed. Results: Location of the primary tumor was pancreas head (n = 20), ampulla of Vater (n = 10), distal bile duct (n = 5), or duodenum (n = 5). Most patients (n = 27) presented with synchronous disease, while 13 patients presented with metachronous disease following a median disease-free interval of 22 months. Most patients (n = 25) presented with hepatic metastasis from pancreaticobiliary origin (pancreatic or distal common bile duct) compared with 15 patients who had metastasis from an intestinal-type primary (ampullary or duodenal). There were no differences in metastatic tumor number or size between these groups (P > 0.05). Post-operative morbidity and mortality was 30% and 5% respectively. Overall 1- and 3-year survival was 55% and 18%. Patients who underwent resection of liver metastasis from intestinal-type tumors experienced a longer survival compared with patients who had pancreaticobiliary lesions (median: 13 months vs. 23 months; P = 0.05). Conclusion: Curative intent surgery for peri-ampullary liver metastasis was associated with post-operative morbidity and a 5% mortality rate. Although the overall survival benefit was modest, patients with liver metastasis from intestinal-type tumors experienced improved survival following resection of liver metastasis compared with pancreaticobiliary lesions.

Original languageEnglish (US)
Pages (from-to)256-263
Number of pages8
JournalJournal of Surgical Oncology
Volume102
Issue number3
DOIs
StatePublished - Sep 1 2010

Keywords

  • Metastasis
  • Outcomes
  • Peri-ampullary cancer
  • Recurrence
  • Resection

ASJC Scopus subject areas

  • Surgery
  • Oncology

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    De Jong, M. C., Tsai, S., Cameron, J. L., Wolfgang, C. L., Hirose, K., Van Vledder, M. G., Eckhauser, F., Herman, J. M., Edil, B. H., Choti, M. A., Schulick, R. D., & Pawlik, T. M. (2010). Safety and efficacy of curative intent surgery for peri-ampullary liver metastasis. Journal of Surgical Oncology, 102(3), 256-263. https://doi.org/10.1002/jso.21610