Eighty six consecutive cases of resectable ampulla of Vater cancer during the period of 10 years from 1986 to 1995 were reviewed to determine the prognostic factors for postoperative survival. The surgical resectability rate was 96.7% and the 5
year
survival rate was 62.7%. The clinicopathological variables evaluated for prognostic values were age, sex, preoperative percutaneous transhepatic biliary drainage (PTBD), preoperative maximum bilirubin(≤5mg%, >5mg%), preoperative lowest
bilirubin(≤5mg%, >5mg%), type of operation (Whipple operation, Pyrolus preserving pancreatoduodenectomy), intraoperative transfusion, tumor size(≤2cm, >2cm), histology(papillary, well differentiated, moderately differentiated, poorly
differentiated),
depth of invasion(confined to ampulla, duodenal invasion, pancreatic invasion), lymph node metastasis, duodenal invasion, pancreatic invasion, and perineural invasion. Univariate analysis of overall survival rate showed the 5 factors;
preoperative
maximum bilirubin, preoperative PTBD, depth of invasion, pancreatic invasion, lymph node metastasis-had prognostic significance (p<0.05).
Multivariate analysis using Weibull model involving above 5 factors identified two significant factors-depth of invasion and lymph node metastasis(p<0.05). Therefore depth of invasion and lymph node metastasis were the independent significant
prognostic
factors of resectable ampulla of Vater cancer and those who have these factors should be considered as high risk patients for recurrence and candidates for further adjuvant therapy.
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