Back to Annual Meeting Posters

Background:
Ampullary neoplasms are a rare subset of intestinal cancers, the only treatment for which is complete surgical resection. Controversy exists, however, with regard to need for and type of adjuvant therapy. The management approach is even less clear for those patients in whom the disease recurs. In this report, we aim to determine patient and histological factors predictive of recurrence, and to describe the survival experience of those with recurrent disease.
Methods:
Patients who underwent surgical resection for ampullary adenocarcinoma at our institution were identified, and histological diagnosis was confirmed by independent pathologist review. Presenting features, operative characteristics, postoperative outcomes, and overall and disease free survival were evaluated. Selected resection specimens were stained for presence of CK7, CK20, and CDX2 using standard methods.
Continuous variables were compared using Student's t-test. Categorical variables were compared using chi-square or Fisher's exact test. Predictors of recurrence were analyzed using logistic regression. Survival was evaluated using Kaplan-Meier method, and differences among groups were assessed by log-rank test.
Results:
Between 1990 and 2011, 79 patients underwent pancreaticoduodenectomy for ampullary adenocarcinoma. Thirty patients received adjuvant chemotherapy, which was gemcitabine based for 29 (96.6%). Among 74 R0 resections, there were 24 cases of recurrence over 273 person-years (median follow-up 28.7 months, median time to recurrence 8.7 months). Four (16.7%) were in the surgical bed and 20 (83.3%) distantly, predominantly in the liver. In univariable analysis, no single demographic or clinical characteristic, nor histologic staining pattern, was a statistically significant predictor of recurrence. Lymph node positivity was significant in univariable but not in multivariable analysis, and pathologic T stage was unassociated with recurrence. Recurrent disease was managed by surgical resection in 2 cases, one local and one metastatic, after which the patients survived 15.8 and 3.4 months, respectively. Fifteen patients received chemotherapy (either 5FU or gemcitabine based) only. Systemic therapy was not offered to 2 patients. Post-recurrence survival was not significantly different among those who had surgery, chemotherapy, or no treatment (8.8 vs 8.0 vs 3.9 months, p=0.39). Additionally, among those who received chemotherapy, difference in median post-recurrence survival was not statistically significant in 5FU compared with gemcitabine groups (16 vs 3.5 months, p=0.107).
Conclusions:
Optimal treatment approach for recurrent ampullary adenocarcinoma remains unclear. Survival is equivalent whether surgical resection or systemic chemotherapy is employed, and no single cytotoxic protocol is associated with improved outcome.