Z Gastroenterol 2019; 57(09): e319
DOI: 10.1055/s-0039-1695457
Gastroenterologische Onkologie
Pankreaskarzinom: Medikamentöse Therapie: Freitag, 04. Oktober 2019, 16:45 – 17:57, Studio Terrasse 2.2 A
Georg Thieme Verlag KG Stuttgart · New York

Subtype specific benefit from adjuvant therapy in ampullary cancer

L Bolm
1   UKSH Campus Lübeck, Department of Surgery, Lübeck, Deutschland
,
K Ohrner
2   Humanitas Research Hospital, Department of Surgery, Unit of Pancreatic Surgery, Milano, Italien
,
N Gennaro
2   Humanitas Research Hospital, Department of Surgery, Unit of Pancreatic Surgery, Milano, Italien
,
F Rückert
3   University Medical Center Mannheim, Department of Surgery, Mannheim, Deutschland
,
BM Rau
4   Hospital Neumarkt in der Oberpfalz, Department of Surgery, Neumarkt i.d.Opf., Deutschland
,
E Petrova
1   UKSH Campus Lübeck, Department of Surgery, Lübeck, Deutschland
,
D Bausch
1   UKSH Campus Lübeck, Department of Surgery, Lübeck, Deutschland
,
J Weitz
5   University Hospital, Technical University Dresden, Department for Visceral, Thoracic and Vascular Surgery, Dresden, Deutschland
,
M Sandini
6   San Gerardo Hospital of Milano Bicocca University, Department of Surgery, Monza, Italien
,
T Keck
1   UKSH Campus Lübeck, Department of Surgery, Lübeck, Deutschland
,
A Zerbi
2   Humanitas Research Hospital, Department of Surgery, Unit of Pancreatic Surgery, Milano, Italien
,
M Distler
5   University Hospital, Technical University Dresden, Department for Visceral, Thoracic and Vascular Surgery, Dresden, Deutschland
,
U Wellner
1   UKSH Campus Lübeck, Department of Surgery, Lübeck, Deutschland
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Publikationsverlauf

Publikationsdatum:
13. August 2019 (online)

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    Background and purpose:

    Ampullary cancer (AMPAC) is a rare malignancy and the benefit of adjuvant therapy is debated. We aimed to evaluate long-term overall survival, prognostic factors and the role of adjuvant therapy after pancreatoduodenectomy (PD) in a large multicenter cohort.

    Methods:

    Patients undergoing PD for AMPAC at 5 high-volume European surgical centers from 1996 to 2017 were identified. Patient baseline characteristics, surgical and histopathological parameters, as well as long-term overall survival (OS) after resection were evaluated.

    Results:

    A total of 202 patients undergoing PD for ampullary cancer were included. In univariable survival analysis, higher T stage (T1 – 2 196 months vs. T 3 – 4 112 months median OS, p < 0.001), positive N stage (N0 198 months vs. N+ 118 months, p = 0.003), pancreatobiliary or mixed subtype (PB/M) (intestinal subtype 163 months vs. PB/M subtype 81 months median OS, p = 0.030) and positive resection margins (R0 171 vs. R1 42 months median OS, p = 0.046) qualified as negative prognostic parameters. In multivariable analysis, ASA score (HR 2.166, 95%CI 1.001 – 4.685, p = 0.050) and N stage (HR 3.630, 95%CI 1.318 – 9.997, p = 0.013) remained independent prognostic factors. In the subgroup of PB/M histological subtype AMPAC, patients undergoing adjuvant therapy showed an improved overall survival (adjuvant therapy 81 months vs. no adjuvant therapy 61 months median OS, p = 0.023). There was no significant benefit of adjuvant therapy in intestinal subtype AMPAC patients (adjuvant therapy 85 months vs. no adjuvant therapy 140 months median OS, p = 0.310).

    Conclusion:

    Adjuvant treatment seems indicated in pancreatobiliary or mixed type AMPAC, but needs to be critically assessed in intestinal type AMPAC.


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