Carcinoma of the ampulla of Vater.

A retrospective study of 56 patients with carcinoma of the ampulla of Vater revealed a resectability rate of 79.0 per cent and an operative mortality of 2.3 per cent. Although 55 per cent of those undergoing pancreaticoduodenectomy had complications postoperatively, these were usually self-limiting and did not require operative intervention. The five year survival rate was 23 per cent. The most significant pathologic determinant of long term survival was the nodal status at the time of exploration. Local recurrence after resection for cure was common as the first site of treatment failure and raises the question of the value of a more aggressive surgical approach or adjuvant radiation therapy to the surgical fields. The reason for a local recurrence appeared to be failure to remove all microscopic disease at the initial operation. Multifocal origin within the biliary tract could have contributed to the local recurrence. However, residual disease within the remaining pancreas after pancreaticoduodenectomy was a problem in only one patient. When disease was locally advanced, short term palliation was best accomplished by pancreaticoduodenectomy. However, survival beyond two years was no different from that of those treated by simple biliary bypass.