Ann Hepatobiliary Pancreat Surg.  2021 Feb;25(1):90-96. 10.14701/ahbps.2021.25.1.90.

Prognostic value of the lymph node metastasis in patients with ampulla of Vater cancer after surgical resection

• Lee JW
• Choi SB
• Lim TW
• Kim WJ
• Park P
• Kim WB

• KMID: 2513181
• DOI: http://doi.org/10.14701/ahbps.2021.25.1.90

Abstract

Backgrounds/Aims
Patients with Ampulla of Vater cancer have a better prognosis than those with other periampullary cancers. This study aimed to determine the prognostic impact of lymph node metastasis on survival in patients with ampulla of Vater cancer after surgical resection.
Methods
From 1991 to 2016, we retrospectively reviewed data on 104 patients with ampulla of Vater cancer who had received pancreaticoduodenectomy. Clinicopathologic factors such as lymph node ratio (LNR) and number of metastatic lymph nodes that influence survival were statistically analyzed.
Results
5-year survival rate after resection was 57.8%. Mean number of retrieved and metastatic lymph nodes was 13 and 0.95, respectively. In patients with lymph node metastasis, the median number of metastatic lymph nodes and was 1, and the mean LNR was 0.18. LNR ＞0.2 was a significant prognostic factor for overall survival. Patients with 0 or 1 metastatic lymph nodes had better survival than those with ≥2 metastatic lymph nodes. Univariate analysis revealed that histologic differentiation of tumor, lymph node metastasis, and T stage were significant prognostic factors for overall survival. Multivariate analysis revealed that tumor differentiation and number of metastatic lymph nodes were independent prognostic factors for survival.
Conclusions
Pancreaticoduodenectomy is an appropriate surgical procedure with acceptable long-term survival for ampulla of Vater cancer. Patients with LNR ＞0.2 and ≥2 positive lymph node metastasis had a poor survival. Tumor differentiation and ≥2 metastatic lymph nodes were independent significant prognostic factors for overall survival. Curative resection with lymph node dissection might control lymph node spread and enhance survival outcomes.

Keyword

Ampulla of Vater; Lymph node ratio; Lymphatic metastasis

Figure

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  Fig. 1 Overall survival (A) and disease survival curve (B) of patients with Ampulla of Vater cancer after surgical resection.

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  Fig. 2 Overall survival curve according to the number of metastatic lymph nodes (A). Overall survival curve according to lymph node ratio (B). Overall survival curve according to lymph node ratio in the lymph nodes positive patients (C).

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