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.
