Impact of circumferential resection margin on survival in ampullary cancer: retrospective analysis
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Impact of circumferential resection margin on survival in ampullary cancer: retrospective analysis. / Nießen, Anna; Loos, Martin; Neumüller, Katja; Feißt, Manuel; Klaiber, Ulla; Cizmic, Amila; Al-Saeedi, Mohammed; Roth, Susanne; Schneider, Martin; Büchler, Markus W; Hackert, Thilo.
in: BJS OPEN, Jahrgang 7, Nr. 6, zrad120, 01.11.2023.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Impact of circumferential resection margin on survival in ampullary cancer: retrospective analysis
AU - Nießen, Anna
AU - Loos, Martin
AU - Neumüller, Katja
AU - Feißt, Manuel
AU - Klaiber, Ulla
AU - Cizmic, Amila
AU - Al-Saeedi, Mohammed
AU - Roth, Susanne
AU - Schneider, Martin
AU - Büchler, Markus W
AU - Hackert, Thilo
N1 - © The Author(s) 2023. Published by Oxford University Press on behalf of BJS Society Ltd.
PY - 2023/11/1
Y1 - 2023/11/1
N2 - BACKGROUND: Ampullary carcinoma is a clinically variable entity. This study aimed to evaluate prognostic factors for the outcome of resected ampullary carcinoma patients with particular intent to analyse the influence of surgical radicality.METHODS: Patients undergoing resection between 2002 and 2017 were analysed. Clinicopathological parameters, perioperative outcome and survival were examined. Risk factor analysis for postresection survival was performed. Resection margin status was evaluated according to the revised classification for pancreatic adenocarcinoma.RESULTS: A total of 234 patients were identified, 97.9 per cent (n = 229) underwent formal resection, while 2.1 per cent (n = 5) underwent ampullary resection. Histological subtypes were 46.6 per cent (n = 109) pancreatobiliary, 34.2 per cent (n = 80) intestinal, 11.5 per cent (n = 27) mixed, and 7.7 per cent (n = 18) undetermined. In the pancreatobiliary group, tumours were more advanced with more vascular resections, pT4 stage, G3 differentiation and pN+ status. Five-year overall survival was significantly different for pancreatobiliary compared to intestinal (51.7 per cent versus 72.8 per cent, P = 0.0087). In univariable analysis, age, pT4 stage, pN+, pancreatobiliary subtype and positive resection margin were significantly associated with worse overall survival. Long-term outcome was significantly better after true R0 resection (circumferential resection margin-, tumour clearance >1 mm) compared with circumferential resection margin+ (<1 mm) and R1 resections (5-year overall survival: 69.6 per cent, median overall survival 191 months versus 42.4 per cent and 53 months; P = 0.0017).CONCLUSION: Postresection survival of ampullary carcinoma patients is determined by histological subtype and surgical radicality. Intestinal differentiation is associated with less advanced tumour stages and better differentiation, which is reflected in a significantly better overall survival compared to pancreatobiliary differentiation. Despite this, true R0-resection is a prognostic key determinant in both entities, achieving 5-year survival in two-thirds of patients.
AB - BACKGROUND: Ampullary carcinoma is a clinically variable entity. This study aimed to evaluate prognostic factors for the outcome of resected ampullary carcinoma patients with particular intent to analyse the influence of surgical radicality.METHODS: Patients undergoing resection between 2002 and 2017 were analysed. Clinicopathological parameters, perioperative outcome and survival were examined. Risk factor analysis for postresection survival was performed. Resection margin status was evaluated according to the revised classification for pancreatic adenocarcinoma.RESULTS: A total of 234 patients were identified, 97.9 per cent (n = 229) underwent formal resection, while 2.1 per cent (n = 5) underwent ampullary resection. Histological subtypes were 46.6 per cent (n = 109) pancreatobiliary, 34.2 per cent (n = 80) intestinal, 11.5 per cent (n = 27) mixed, and 7.7 per cent (n = 18) undetermined. In the pancreatobiliary group, tumours were more advanced with more vascular resections, pT4 stage, G3 differentiation and pN+ status. Five-year overall survival was significantly different for pancreatobiliary compared to intestinal (51.7 per cent versus 72.8 per cent, P = 0.0087). In univariable analysis, age, pT4 stage, pN+, pancreatobiliary subtype and positive resection margin were significantly associated with worse overall survival. Long-term outcome was significantly better after true R0 resection (circumferential resection margin-, tumour clearance >1 mm) compared with circumferential resection margin+ (<1 mm) and R1 resections (5-year overall survival: 69.6 per cent, median overall survival 191 months versus 42.4 per cent and 53 months; P = 0.0017).CONCLUSION: Postresection survival of ampullary carcinoma patients is determined by histological subtype and surgical radicality. Intestinal differentiation is associated with less advanced tumour stages and better differentiation, which is reflected in a significantly better overall survival compared to pancreatobiliary differentiation. Despite this, true R0-resection is a prognostic key determinant in both entities, achieving 5-year survival in two-thirds of patients.
KW - Humans
KW - Ampulla of Vater/surgery
KW - Retrospective Studies
KW - Pancreatic Neoplasms/pathology
KW - Prognosis
KW - Adenocarcinoma
KW - Margins of Excision
KW - Common Bile Duct Neoplasms/surgery
U2 - 10.1093/bjsopen/zrad120
DO - 10.1093/bjsopen/zrad120
M3 - SCORING: Journal article
C2 - 38155394
VL - 7
JO - BJS OPEN
JF - BJS OPEN
SN - 2474-9842
IS - 6
M1 - zrad120
ER -
