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Outcomes and recurrence patterns following resection of T1 ampullary carcinomas: single centre experience of 92 cases
Gurudutt P Varty1, Arindam Mondal2, Siva Sumanth Dukkipati3
1Hepato-pancreato-biliary & Upper Gastrointestinal Surgery, Department of Surgical Oncology, ACTREC, Navi Mumbai, Maharashtra, India.
Background:
Resected early-stage (T1) ampullary carcinomas (ACs) have the best overall survival (OS) but can have higher postoperative morbidity compared to higher-stage ACs and other periampullary cancers.
Method:
A retrospective analysis of resected T1-ACs at Tata Memorial Centre, Mumbai, from January 2012 to December 2022 was performed. Perioperative and long-term outcomes were assessed.
Results:
A total of 92 patients underwent resection for T1-ACs, with a significant morbidity rate (Clavien-Dindo ≥3) of 38%, and a clinically relevant postoperative pancreatic fistula rate of 22.5%. The node positivity rate in resected T1-ACs was 25%. The 3- and 5-year OS rates were 77.9% and 74.5%, while recurrence-free survival (RFS) rates were 81.8% and 78.4%, respectively. There were 18 (19.6%) recurrences (2 local, 16 distant) during a median follow-up of 66.7 months. The 3- and 5-year OS after recurrence was 29.6% and 14.8% respectively. Lymph node metastasis was the sole significant factor affecting OS (HR 2.815, 95% CI: 1.114-7.112, p = 0.029) and RFS (HR 2.54, 95% CI: 0.978-6.595, p = 0.056).
Conclusion:
T1-ACs have excellent survival after resection; however, about 20% of patients develop recurrence. Lymph node metastasis remains the most important factor affecting long-term survival.
