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Background: Ampullary carcinoma (AC) is a rar entity accounting for only 6% of all periampullary tumors. These often present earlier due to proximity to the common bile duct or pancreatic duct. Despite this, rates of local recurrence have been documented as high as 50%, even with an R0 resection. No randomized trial addresses the role of chemoradiation, as reflected in current NCCN guidelines. The purpose of this study is to assess the role of chemoradiation for AC. Aim: A retrospective analysis of patients with AC, identifying and analyzing demographics, clinical stage at presentation, surgical procedures, pathological stage (7th Edition AJCC) , neo-adjuvant & adjuvant treatment and complications of surgery. Results: Forty five patients were identified. Seventy percent were female with 48% staged 2b and higher. Twenty eight patients had N0 disease (Group A) compared to 17 N1 patients (Group B). Seven patients received adjuvant chemotherapy only, 3 adjuvant radiotherapy only, with 12 patients receiving both therapies. Twenty-five per cent of the N0 group compared to 82% of the N1 group had adjuvant therapy(p=0.004). Overall survival and recurrence free survival by N0 status and adjuvant therapy demonstrated no difference (p=0.664,p=0.610). Survival of N1 and adjuvant therapy was better for those receiving postoperative chemoradiotherapy (p=0.035). Overall median survival for N0 and N1 was 58 and 53 months. Median survival stratified by nodal status and adjuvant therapy was 58 months for either group by N0 status. Those N1 patients receiving adjuvant therapy had a median survival of 78 months, compared to the 21 months for those who did not(p =0.035). Median follow up was 27.5 months. Conclusions: Adjuvant therapy should be considered for AC patients with node positive cancer. Identification of risk factors for recurrence in the node negative patient who may benefit from adjuvant therapy should be further investigated.

Survival of node positive ampullary carcinoma by adjuvant therapy