Carcinoma of the ampulla of Vater: a community hospital experience

Carcinoma of the ampulla of Vater is an uncommon malignancy often treated at tertiary referral centers. Most published series are derived from these centers and show resectability rated of 80 to 90 percent, with overall 5 year survival rates of 25 to 60 per cent. Twenty cases of ampullary carcinoma treated in a community hospital setting were reviewed. The mean age at diagnosis was 69 years (range, 49-89), and 65 per cent of the patients were female. The most common presenting symptoms were jaundice (85%) and abdominal pain (50%). Stages at diagnosis included stage II, 12 patients; stage III, 5 patients; and stage IV, 3 patients. Nine patients underwent curative resections (resectability rate, 45%), of which five were pylorus-preserving pancreaticoduodenectomies and four were standard pancreaticoduodenectomies. There were no operative mortalities. Overall survival was 23 per cent, while survival in the resected patients was 60 per cent at 2 years. The majority of the patients not resected were felt to be poor candidates for major surgery either because of significant comorbid disease or advanced age. Three patients presented with advanced disease, and two patients died within 7 days of presentation. This review demonstrated a significantly lower resectability rate for carcinoma of the ampulla of Vater, with comparable survival rates. Differences from published studies at tertiary referral centers reflect a selection bias of patients referred to these centers.