Rare Cancer News & Clinical Trials

Ampulla Of Vater (23 unread)

Trial - Ampullary Carcinoma

Study of S-1 Oxaliplatin (SOX) for Biliary Tract Cancer (BTC) (Ampullary Adenocarcinoma)

Posted: August 9th, 2010, 9:00am CDT

Condition: Biliary Tract Cancer
Intervention: Drug: S-1 oxaliplatin
Sponsor: Beijing Cancer Hospital
Not yet recruiting - verified August 2010
Comparison Between Internal and External Preoperative Biliary Drainage in Periampullary Cancers

Posted: May 4th, 2010, 9:00am CDT

Conditions: Periampullary Cancers Causing Obstructive Jaundice; Pancreas Head Cancer; Bile Duct Cancer; Ampulla of Vater Cancer
Intervention: Procedure: biliary drainage
Sponsor: Seoul National University Hospital
Not yet recruiting - verified August 2010
Vandetanib Gemcitabine Or Placebo Plus Gemcitabine Or Vandetanib Monotherapy In Advanced Biliary Tract Cancer

Posted: September 15th, 2008, 9:00am CDT

Conditions: Biliary Tract Cancer; Gallbladder Cancer; Cancer Of The Extrahepatic Bile Duct; Ampullary Carcinoma
Interventions: Drug: ZD6474, VANDETANIB; Drug: ZD6474, VANDETANIB; Drug: GEMCITABINE; Drug: Placebo matching ZD6474
Sponsor: AstraZeneca
Recruiting - verified July 2010
Endoscopic Versus Percutaneous Drainage For Hilar Block in Gall Bladder Cancer

Posted: December 8th, 2006, 9:00am CST

Conditions: Gallbladder Cancer; Obstructive Jaundice
Intervention: Procedure: Endoscopic biliary stenting, Percutaneous biliary stenting
Sponsor: All India Institute of Medical Sciences, New Delhi
Completed - verified December 2006

PubMed - Ampullary Cancer

Prominin-1 (CD133) is not restricted to stem cells located in the basal compartment of murine and human prostate.

Fetched: September 1st, 2010, 9:30am CDT

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Prominin-1 (CD133) is not restricted to stem cells located in the basal compartment of murine and human prostate.

Prostate. 2010 Aug 17;

Authors: Missol-Kolka E, KarbanovÃ¡ J, Janich P, Haase M, Fargeas CA, Huttner WB, Corbeil D

BACKGROUND: Rodent and human prominin-1 are expressed in numerous adult epithelia and somatic stem cells. A report has shown that human PROMININ-1 carrying the AC133 epitope can be used to identify rare prostate basal stem cells (Richardson et al., J Cell Sci 2004; 117:3539-3545). Here we re-investigated its general expression in male reproductive tract including mouse and human prostate and in prostate cancer samples using various anti-prominin-1 antibodies. METHODS: The expression was monitored by immunohistochemistry and blotting. Murine tissues were stained with 13A4 monoclonal antibody (mAb) whereas human samples were examined either with the AC133 mAb recognizing the AC133 glycosylation-dependent epitope or 80B258 mAb directed against the PROMININ-1 polypeptide. RESULTS: Mouse prominin-1 was detected at the apical domain of epithelial cells of ductus deferens, seminal vesicles, ampullary glands, and all prostatic lobes. In human prostate, immunoreactivity for 80B258, but not AC133 was revealed at the apical side of some epithelial (luminal) cells, in addition to the minute population of AC133/80B258-positive cells found in basal compartment. Examination of prostate adenocarcinoma revealed the absence of 80B258 immunoreactivity in the tumor regions. However, it was found to be up-regulated in luminal cells in the vicinity of the cancer areas. CONCLUSIONS: Mouse prominin-1 is widely expressed in prostate whereas in human only some luminal cells express it, demonstrating nevertheless that its expression is not solely associated with basal stem cells. In pathological samples, our pilot evaluation shows that PROMININ-1 is down-regulated in the cancer tissues and up-regulated in inflammatory regions. Prostate (c) 2010 Wiley-Liss, Inc.

PMID: 20717901 [PubMed - as supplied by publisher]
Survival After Pancreaticoduodenectomy for Ampullary Cancer is not Affected by Age.

Fetched: September 1st, 2010, 9:30am CDT

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Survival After Pancreaticoduodenectomy for Ampullary Cancer is not Affected by Age.

World J Surg. 2010 Aug 17;

Authors: Yeh CC, Jeng YM, Ho CM, Hu RH, Chang HP, Tien YW

BACKGROUND: Although pancreaticoduodenectomy (PD) provides the best chance of survival for elderly patients with ampullary carcinoma, it is associated with considerable surgical risk. The aim of the present study was to compare the benefits and risks of pancreaticoduodenectomy as a treatment of ampullary carcinoma between young and elderly patients. PATIENTS AND METHODS: We retrospectively reviewed the medical records of 171 consecutive patients treated at our hospital. Comparison of the biological aggressiveness of ampullary cancer between old and younger patients was also performed by immunohistochemical study of several prognostic biological markers, including MUC1, MUC2, CK17, and CDX2. RESULTS: For patients in whom ampullary carcinoma was presumed resectable preoperatively, actuarial survival was significantly poorer in 55 elderly patients because 9 of them did not have PD (the other 46 had PD) than in 101 younger patients (all had PD). Multivariate analysis indicated that PD was the only independent prognostic factor; age was not. There were no significant differences in MUC1, CK17, MUC2, and CDX2 immunohistochemical staining of ampullary carcinomas between elderly and young patients. In spite of increased co-morbidities, PD could be performed as safely in elderly patients as in young patients. After PD, the actuarial survivalwas similar between old and young patients. CONCLUSIONS: Our data support the conclusion that ampullary cancers in elderly patients should be treated as aggressively as in younger patients.

PMID: 20714897 [PubMed - as supplied by publisher]
Predicting patient survival after pancreaticoduodenectomy for malignancy: histopathological criteria based on perineural infiltration and lymphovascular invasion.

Fetched: September 1st, 2010, 9:30am CDT

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Predicting patient survival after pancreaticoduodenectomy for malignancy: histopathological criteria based on perineural infiltration and lymphovascular invasion.

HPB (Oxford). 2010 Mar;12(2):101-8

Authors: Chen JW, Bhandari M, Astill DS, Wilson TG, Kow L, Brooke-Smith M, Toouli J, Padbury RT

BACKGROUND: Accurate and simple prognostic criteria based on histopathology following pancreaticoduodenectomy would be helpful in assessing prognosis and considering and evaluating adjuvant therapy. This study analysed the histological parameters influencing outcome following pancreaticoduodenectomy for periampullary malignancy. METHODS: A total of 110 pancreaticoduodenectomies were performed from 1998 to 2008. The median age of patients was 69 years (range 20-89 years). The median follow-up was 4.9 years. Of the procedures, 87% (96) were performed for malignancies and the remainder (n= 14) for benign aetiologies. Of the 96 malignancies, 60 were pancreatic adenocarcinoma and the rest were ampullary (14), cholangio (9), duodenal (9) carcinomas and others. Statistical analysis was performed using log-rank and Cox regression multivariate analyses. RESULTS: Patients who underwent resection had 1-, 3- and 5-year survival rates of 70%, 46% and 41%, respectively. The 1-, 3- and 5-year survival rates for periampullary cancers other than pancreatic adenocarcinoma were 83%, 69% and 61%, respectively; those for pancreatic adenocarcinoma were 62%, 31% and 27%, respectively (P < 0.003). Poor tumour differentiation (P < 0.02), tumour size >3 cm (P < 0.04), margin <or=2 mm (P < 0.02), nodal involvement (P < 0.003), perineural infiltration (P < 0.0001) and lymphovascular invasion (P < 0.002) were associated with poorer prognosis. In a multivariate analysis, histologically identified perineural infiltration (P < 0.03) and lymphovascular invasion (P= 0.05) were significant factors influencing outcome. Five-year survival was 77% in patients negative for both factors and 15% in patients positive for both (P < 0.0001). In the pancreatic adenocarcinoma subgroup, patients who were negative for both factors had a 5-year survival of 71%, whereas those who were positive for both had a 5-year survival of 16% (P < 0.02). CONCLUSIONS: The presence of perineural infiltration and lymphovascular invasion on histopathology is highly significant in predicting 5-year outcomes after pancreaticoduodenectomy for periampullary and pancreatic malignancies.

PMID: 20495653 [PubMed - indexed for MEDLINE]
Immunohistochemical study of mucin expression in periampullary adenomyoma.

Fetched: September 1st, 2010, 9:30am CDT

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Immunohistochemical study of mucin expression in periampullary adenomyoma.

J Hepatobiliary Pancreat Sci. 2010 May;17(3):275-83

Authors: Higashi M, Goto M, Saitou M, Shimizu T, Rousseau K, Batra SK, Yonezawa S

BACKGROUND/PURPOSE: Benign tumors and tumor-like conditions in the ampullary area are uncommon, and there are extremely rare cases of adenomyoma (AM) and adenomyomatous hyperplasia (AMH). Surgical treatment is necessary if these lesions cause biliary obstruction. In addition, the differential diagnosis of AM and AMH from carcinoma is often difficult by standard endoscopic biopsy and cytopathological analysis that may show differential findings, resulting in unnecessary surgeries sometimes being performed. METHODS: Immunohistochemical (IHC) analysis of periampullary AM and AMH was performed. RESULTS: For both types of lesions, epithelial glandular cells (EGCs) showed diffuse expression of MUC6 and focal expression of HIK1083, mainly in the inner region, and focal expression of MUC5AC, mainly at the surface. The EGCs showed no expression of MUC1 or MUC4, both of which were identified as malignant tumor markers in our previous series of mucin expression studies in pancreatobiliary tumors. The expression of CK7, which was diffusely positive in normal periampullary mucosa, was decreased in the EGCs of AM and AMH. CONCLUSIONS: A combined evaluation of IHC findings may be effective in the detection of AM and AMH, and also in distinguishing benign periampullary lesions, such as AM and AMH, from ampulla of Vater adenocarcinoma, thus avoiding excessive surgery.

PMID: 19784541 [PubMed - indexed for MEDLINE]
[Carcinoma of the head of the pancreas: indication for emergency surgery.]

Fetched: August 13th, 2010, 9:16pm CDT

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[Carcinoma of the head of the pancreas: indication for emergency surgery.]

Ned Tijdschr Geneeskd. 2010;154(29):A2148

Authors: Gooszen H

In a recent multicentre randomized clinical trial, Van der Gaag et al. randomly assigned 220 patients to early surgery or preoperative biliary drainage ('Preoperative drainage for cancer of the head of the pancreas'). The rate of serious complications was significantly higher in the preoperative drainage group (p < 0.001), mainly because of drainage-related complications. There was no difference in surgical complications or mortality. Data on costs and impact on quality of life were not presented, but it can be predicted that the preoperative drainage strategy would be more expensive and would have greater negative impact on quality of life. If forthcoming publications by this research group confirm this suggestion, the current paradigm - obstructive jaundice, endoscopic retrograde cholangiopancreatography with stenting, delayed surgery for carcinoma of the head of the pancreas - should be changed to: obstructive jaundice due to peri-ampullary carcinoma should be considered an indication for emergency surgery.

PMID: 20699039 [PubMed - in process]
Gallbladder perforation associated with carcinoma of the duodenal papilla: a case report.

Fetched: August 10th, 2010, 6:31pm CDT

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Gallbladder perforation associated with carcinoma of the duodenal papilla: a case report.

World J Surg Oncol. 2010;8:41

Authors: Hosaka A, Nagayoshi M, Sugizaki K, Masaki Y

BACKGROUND: Gallbladder perforation is a rare clinical condition, which mostly occurs following acute cholecystitis associated with cholelithiasis. A tumor of the ampulla of Vater causes gradually progressive symptoms, and is rarely associated with perforation of the gallbladder. CASE PRESENTATION: A 56-year-old man with carcinoma of the ampulla of Vater presented with spontaneous gallbladder perforation and localized bile peritonitis. He complained of right upper abdominal pain, and laparotomy revealed perforation of the gallbladder with no gallstones. Postoperative upper gastrointestinal endoscopy demonstrated a slightly enlarged duodenal papilla, and biopsy revealed adenocarcinoma of the ampulla. Pylorus-preserving pancreaticoduodenectomy was performed subsequently. CONCLUSION: Ampullary carcinoma can be associated with gallbladder perforation and present with acute manifestations. Immediate surgical treatment is required for this condition.

PMID: 20487525 [PubMed - indexed for MEDLINE]
Cisplatin plus gemcitabine versus gemcitabine for biliary tract cancer.

Fetched: August 4th, 2010, 9:26am CDT

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Cisplatin plus gemcitabine versus gemcitabine for biliary tract cancer.

Expert Rev Gastroenterol Hepatol. 2010 Aug;4(4):395-7

Authors: Weigt J, Malfertheiner P

Evaluation of: Valle J, Wasan H, Palmer DH et al. Cisplatin plus gemcitabine versus gemcitabine for biliary tract cancer. N. Engl. J. Med. 362, 1273-1281 (2010). Biliary tract cancer is a rare disease and it is associated with a poor clinical outcome and survival. A standard therapy has not been established yet. The evaluated article reports on the first Phase III randomized controlled multicenter trial (ABC-02 trial) on palliative chemotherapy for biliary tract cancer. A total of 410 patients with locally advanced or metastatic cholangiocarcinoma, gallbladder cancer or ampullary cancer were included to receive either cisplatin followed by gemcitabine or gemcitabine alone for up to 24 weeks. The primary end point was overall survival and the secondary end point was progression-free survival. The median overall survival was 11.7 months in the cisplatin plus gemcitabine group and 8.1 months in the gemcitabine only group. The median progression-free survival was 8.0 months in the cisplatin plus gemcitabine group and 5.0 months in the gemcitabine-only group (p < 0.001). Adverse events were comparable in the two groups. Cisplatin plus gemcitabine, compared with gemcitabine alone, was associated with a significant survival advantage without an increase in substantial toxicity.

PMID: 20678012 [PubMed - in process]
Gemcitabine with carboplatin for advanced biliary tract cancers: a phase II single institution study.

Fetched: August 4th, 2010, 9:26am CDT

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Gemcitabine with carboplatin for advanced biliary tract cancers: a phase II single institution study.

HPB (Oxford). 2010 Aug;12(6):418-26

Authors: Williams KJ, Picus J, Trinkhaus K, Fournier CC, Suresh R, James JS, Tan BR

Background: Only recently has a standard chemotherapy regimen, gemcitabine plus cisplatin, been established for advanced biliary tract cancers (BTCs) based on a phase III randomized study. The aim of this phase II single-institution trial was to assess the efficacy and safety of gemcitabine combined with carboplatin in the first-line treatment of patients with advanced BTCs. Methods: Patients with histologically proven BTCs, including cholangiocarcinoma or gallbladder and ampullary carcinomas, were treated with a maximum of nine cycles of intravenous (i.v.) gemcitabine at 1000 mg/m(2) over 30 min on days 1 and 8 with i.v. carboplatin dosed at an area-under-the-curve (AUC) of 5 over 60 min on day 1 of a 21-day cycle. Results: A total of 48 patients with advanced BTCs (35 cholangiocarcinoma, 12 gallbladder and 1 ampullary cancer) were enrolled. A median of four cycles were administered (range: 1-9). The overall response rate for evaluable patients was 31.1%. Median progression-free survival, overall survival and 6-month survival rates are 7.8 months, 10.6 months and 85.4%, respectively. The most common grade 3-4 toxicities include neutropenia and thrombocytopenia. Grade 3 or 4 non-haematological toxicities were rare. Conclusions: Gemcitabine combined with carboplatin has activity against advanced BTCs. Our results are comparable to other gemcitabine-platinum or gemcitabine-fluoropyrimidine combinations in advanced BTCs.

PMID: 20662793 [PubMed - in process]
Gastric and pancreatoduodenal resection for malignant lesions after previous gastric bypass-diagnosis and methods of reconstruction.

Fetched: August 4th, 2010, 9:26am CDT

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Gastric and pancreatoduodenal resection for malignant lesions after previous gastric bypass-diagnosis and methods of reconstruction.

Surg Obes Relat Dis. 2010 Apr 1;

Authors: Swain JM, Adams RB, Farnell MB, Que FG, Sarr MG

BACKGROUND: The diagnosis and treatment of gastric and pancreatoduodenal neoplasms after previous gastric bypass has been limited. Experience should increase in the future owing to the number of bariatric procedures being performed. The diagnosis and resection of these neoplasms and restoration of biliopancreatic intestinal continuity pose challenges. We present a 2-institutional experience of diagnosis and reconstruction after resection of gastric and pancreatoduodenal neoplasms and discuss the technical options for reconstruction. METHODS: The medical records were reviewed retrospectively from 2003 to 2009 for patients with previous gastric bypass who developed a gastric or pancreatoduodenal neoplasm. RESULTS: Of the available patients, 7 were identified with 2 remnant gastric cancers (2 signet ring cell adenocarcinomas), 4 pancreatic neoplasms (2 adenocarcinomas and 2 neuroendocrine cancers), and 1 ampullary cancer. The gastric neoplasms required complete remnant gastrectomy but did not require additional gastrointestinal reconstruction. The pancreatic and duodenal neoplasms required pancreatoduodenectomy, with 4 of 5 patients also undergoing remnant gastrectomy. The patients after pancreatoduodenectomy required biliary and pancreatic reconstruction with the pancreaticobiliary limb, Roux limb, or proximal common channel, depending on the limb length. Operative mortality was nil, and the morbidity rate was 28%. CONCLUSION: Gastric and pancreatoduodenal neoplasms after previous gastric bypass, although rare, will most likely increase as the number of bariatric operations increases. A high index of suspicion and focused diagnostic testing are key in identifying these lesions. Resection is feasible and safe but could require complex gastric and pancreatobiliary reconstruction.

PMID: 20627707 [PubMed - as supplied by publisher]
Liver-directed therapy for hepatic metastases in patients undergoing pancreaticoduodenectomy: a dual-center analysis.

Fetched: August 4th, 2010, 9:26am CDT

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Liver-directed therapy for hepatic metastases in patients undergoing pancreaticoduodenectomy: a dual-center analysis.

Ann Surg. 2010 Jul;252(1):142-8

Authors: De Jong MC, Farnell MB, Sclabas G, Cunningham SC, Cameron JL, Geschwind JF, Wolfgang CL, Herman JM, Edil BH, Choti MA, Schulick RD, Nagorney DM, Pawlik TM

OBJECTIVES: To analyze the perioperative and long-term outcomes of patients undergoing liver-directed therapy after pancreaticoduodenectomy in a large dual-center cohort of patients. BACKGROUND: Although aggressive liver-directed therapy may be beneficial, liver-directed therapy may be associated with a high risk of complications after pancreaticoduodenectomy. METHODS: Of 5025 patients who underwent pancreaticoduodenectomy at the Johns Hopkins Hospital and the Mayo Clinic between 1970 and 2008, 126 (2.5%), patients were identified who were also treated with either simultaneous or staged liver-directed therapy. Data on demographics, primary tumor, and hepatic metastasis characteristics, as well as details of the liver-directed therapy were collected and analyzed. RESULTS: Primary tumor histology included neuroendocrine carcinoma (34.9%), pancreatic ductal adenocarcinoma (33.4%), distal cholangiocarcinoma (8.7%), ampullary carcinoma (7.1%), duodenal carcinoma (4.0%), or other (11.9%). Liver-directed therapies included hepatic resection alone (45.2%), hepatic resection plus ablation (11.1%), ablation alone (7.9%), transarterial chemoembolization (9.5%), and whole-liver irradiation (22.2%). The overall morbidity following liver-directed therapy was 34.1% and overall mortality was 2.4%. Patients undergoing staged liver-directed therapy (14.5%) versus simultaneous pancreaticoduodenectomy plus liver-directed therapy (7.0%) were more likely to develop a liver abscess (P < 0.05). Of those patients who developed complications, the majority (55.8%) were major (Clavien grade >or=3). CONCLUSIONS: Pancreaticoduodenectomy plus liver-directed therapy is associated with considerable morbidity. The incidence of hepatic abscess is increased in patients undergoing staged pancreaticoduodenectomy followed by liver-directed therapy.

PMID: 20531007 [PubMed - indexed for MEDLINE]
Giant laterally spreading tumors of the papilla: endoscopic features, resection technique, and outcome (with videos).

Fetched: August 4th, 2010, 9:26am CDT

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Giant laterally spreading tumors of the papilla: endoscopic features, resection technique, and outcome (with videos).

Gastrointest Endosc. 2010 May;71(6):967-75

Authors: Hopper AD, Bourke MJ, Williams SJ, Swan MP

BACKGROUND: Successful endoscopic treatment of conventional papillary adenomas is well described. However, many authors recommend surgical resection for larger lesions with extrapapillary extension. OBJECTIVE: To describe the classification, technique, and outcome for the endoscopic resection of giant laterally spreading tumors of the papilla (LST-P). DESIGN: Single-center case series. SETTINGS: Tertiary referral academic gastroenterology unit. PATIENTS: Patients referred for endoscopic treatment of LST-P. INTERVENTION: Pre-resection staging and single-session endoscopic removal of papillary adenomas. For those classified as LST-P (>30 mm, extending beyond the papilla onto the duodenal wall and involving as much as two thirds of the duodenal circumference), a standardized single-session EMR technique was used. MAIN OUTCOME MEASUREMENTS: Technical success, complications, and adenoma recurrence for single-session removal of LST-P. Outcomes were compared with those of conventional ampullary adenoma resection during the same period. RESULTS: Twenty-five patients with ampullary adenomas were referred. In 10 patients identified with LST-P (mean age 70.2 years; adenoma size 30-80 mm), combination EMR and papillectomy was performed in a single session. The median admission duration was 1 night (range 0-35). Complications included bleeding (30%) and cholecystitis (10%), with no cases of pancreatitis or perforation. Adenoma recurrence at 3 months was found in 1 patient (10%). Complication and recurrence rates in smaller (<30 mm) ampullary adenoma resections were not significantly different. LIMITATIONS: A relatively uncommon entity and thus small sample size. CONCLUSIONS: Endoscopic resection of carefully staged LST-P is a viable therapeutic alternative to surgery. In experienced hands, the outcomes are comparable to those for conventional ampullary adenomas.

PMID: 20226451 [PubMed - indexed for MEDLINE]
En bloc resection of the pancreatic head and second part of duodenum for a duodenal gastrointestinal stromal tumor: a multi-media report.

Fetched: July 11th, 2010, 1:34pm CDT

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En bloc resection of the pancreatic head and second part of duodenum for a duodenal gastrointestinal stromal tumor: a multi-media report.

JOP. 2010;11(4):396-400

Authors: Frampton AE, Bong JJ, Kyriakides C, Cohen P, Jiao LR

Duodenal gastrointestinal stromal tumors are rare tumors. When these tumors arise from the second part of the duodenum they can easily be misdiagnosed as a pancreatic head cancer. A case of a 37-year-old female presenting with a one-year history of right upper quadrant pain is described here, who was subsequently found to have a mass in the head of the pancreas. Computed tomography scans showed a 2 cm hypervascular lesion lying between the head of pancreas and the second part of the duodenum, suggestive of a neuroendocrine tumor, and confirmed by endoscopic ultrasound scan. She underwent a pancreatic head resection with duodenal segmentectomy. Histopathological and immunohistochemical analysis revealed the tumor to be peri-ampullary duodenal gastrointestinal stromal tumor not invading the pancreas. Duodenal gastrointestinal stromal tumor can have a wide spectrum of clinical presentation. The accurate diagnosis of duodenal gastrointestinal stromal tumor is essential for determining the appropriate surgical intervention. In our case, a conservative surgical approach was utilised therefore avoiding a formal pancreaticoduodenectomy.

PMID: 20601819 [PubMed - in process]
Predictive Value of Tumor Proliferative Indices in Periampullary Cancers: Ki-67, Mitotic Activity Index (MI) and Volume Corrected Mitotic Index (M/V) Using Tissue Microarrays.

Fetched: June 26th, 2010, 9:50am CDT

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Predictive Value of Tumor Proliferative Indices in Periampullary Cancers: Ki-67, Mitotic Activity Index (MI) and Volume Corrected Mitotic Index (M/V) Using Tissue Microarrays.

World J Surg. 2010 Jun 17;

Authors: Aloysius MM, De Silva Hewavisenthi SJ, Bates TE, Rowlands BJ, Lobo DN, Zaitoun AM

BACKGROUND: Morphometry [nuclear Ki-67 labelling, mitotic activity index (MI), and volume-corrected mitotic index (M/V)] for periampullary cancers using tissue microarrays has not been performed previously. The purpose of the study was to assess these indices on tissue microarray (TMA) sections constructed from patients with periampullary cancers and study their association with clinicopathological variables. METHODS: Immunohistochemical staining for Ki-67 was performed on formalin-fixed pancreatic TMA sections. Expression of Ki-67 was assessed as the percentage of cancer cell nuclei expressing MIB1, MI as the mean percentage of Ki-67 from 10 random high-power fields, and M/V was calculated after standardizing MI for connective tissue volume and microscope parameters in the tumor using established protocols. RESULTS: Patients >/=70 years with periampullary cancers had higher Ki-67 expression (>15) compared with patients <70 years of age (chi(2) = 3.9, P = 0.047). Ki-67 expression was higher in tumors >/=2 cm (chi(2) = 4.9, P = 0.028) compared with smaller tumors. Higher MI (>15) was clearly associated with worsening histological grade (chi(2) = 9.2, P = 0.010). The median survival for tumors of the pancreaticobiliary subtype (pancreatic ductal adenocarcinoma and cholangiocarcinoma) was 43 months in the group with an M/V score of <20, compared with 18 months for the group with a score >/=20 (P = 0.001). There was no statistically significant difference in survival, based on M/V score, for tumors of the intestinal subtype (ampullary and duodenal adenocarcinoma). CONCLUSIONS: In periampullary cancers, Ki-67 and MI are proliferative indices predictive of tumor behavior. M/V was predictive of survival in tumors of the pancreaticobiliary subtype.

PMID: 20556608 [PubMed - as supplied by publisher]
Gross appearance of the ampullary tumor predicts lymph node metastasis and outcome.

Fetched: June 26th, 2010, 9:50am CDT

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Gross appearance of the ampullary tumor predicts lymph node metastasis and outcome.

Dig Surg. 2010;27(2):127-31

Authors: Kayahara M, Ohta T

BACKGROUND/AIMS: Patterns of lymph node involvement in carcinoma of the papilla of Vater (CPV) have not been studied in detail to date, and factors associated with lymphatic metastases and surgical outcome of this disease remain to be determined. METHODS: Lymph node involvement and surgical outcome of 51 CPV patients were evaluated by extended lymphadenectomy specimens. RESULTS: Lymph nodes with high metastatic potential were posterosuperior pancreaticoduodenal nodes (group 13a, 18%), posterior-inferior pancreaticoduodenal nodes (group 13b, 22%), and nodes around the superior mesenteric artery (group 14, 18%). Gross appearance of the primary tumor and depth of tumor invasion correlated with lymph node involvement (p < 0.05, respectively). A correlation with positivity was also found in groups 13 and 14. Disease-specific survival correlated with the gross appearance of the primary tumor and nodal involvement. However, there was no relationship between survival and the level of nodal involvement. Multivariate analysis indicated that the gross appearance of the tumor was the only significant independent predictor of a poor outcome. CONCLUSIONS: Gross appearance of the tumor is the most important prognosticator of lymph node metastases in CPV. Nodal dissection around the superior mesenteric artery may improve survival except in patients without invasion of the sphincter of Oddi. Pylorus-preserving pancreaticoduodenectomy is the treatment of choice.

PMID: 20551657 [PubMed - in process]
Diagnosis of ampullary cancer.

Fetched: June 26th, 2010, 9:50am CDT

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Diagnosis of ampullary cancer.

Dig Surg. 2010;27(2):115-8

Authors: Ito K, Fujita N, Noda Y, Kobayashi G, Horaguchi J

Endoscopic papillectomy has been reported to be the treatment of choice in patients with ampullary adenoma. For ampullary cancer, pancreaticoduodenectomy is the standard treatment. Since neither lymphatic permeation, vascular invasion, nor lymph node metastasis is observed in patients with ampullary cancer limited to the mucosa, endoscopic resection of such tumors can be justified if no ductal infiltration into the bile or pancreatic duct is documented. For its application, accurate preoperative staging is mandatory. Transpapillary intraductal ultrasonography can provide useful information for making therapeutic decisions, especially in the selection of patients for endoscopic papillectomy.

PMID: 20551654 [PubMed - in process]
Reduction of in-hospital mortality following regionalisation of pancreatic surgery in the south-east of The Netherlands.

Fetched: June 26th, 2010, 9:50am CDT

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Reduction of in-hospital mortality following regionalisation of pancreatic surgery in the south-east of The Netherlands.

Eur J Surg Oncol. 2010 May 25;

Authors: Nienhuijs SW, Rutten HJ, Luiten EJ, Repelaer van Driel OJ, Reemst PH, Lemmens VE, de Hingh IH

BACKGROUND: In the late nineties of the former century, surgery for pancreatic and peri-ampullary cancer in the southern part of The Netherlands was performed mainly in low-volume hospitals (<5 resections/year). Results reported by the Comprehensive Cancer Center South (CCCS) in 2005 revealed the clearly disappointing results of this practice. The former stimulated the regionalisation of pancreatic surgery by 3 collaborating surgical units into one non-academic teaching hospital in the eastern part of the CCCS-region starting from July 2005. METHODS: All of the 76 patients in this regional cohort group in whom a resection of a (peri-)pancreatic tumour was performed with curative intent have been followed up prospectively. The results of surgical morbidity and in-hospital mortality were compared with the results of the CCCS cohort group which were reported previously. RESULTS: Ever since the regionalisation the annual number of patients undergoing resection of a pancreatic tumour increased from 10 to 33, resulting in a total number of 76 patients. Post-operative complications, reoperation rate and in-hospital mortality decreased significantly to 34.2%, 18.4% and 2.6% respectively, as compared to 71.9%, 37.8 and 24.4% in the time period before regionalisation (p < 0.01). CONCLUSION: These unique comparative prospective data derived from daily practice in a collaborative surgical region in The Netherlands (CCCS) support the need for centralisation of pancreatic surgery in order to improve standard of care in pancreatic surgery. This can be achieved by collaboration in a large regional hospital.

PMID: 20537840 [PubMed - as supplied by publisher]
Pylorus preserving pancreaticoduodenectomy for peri-ampullary carcinoma, is it a good option?

Fetched: June 26th, 2010, 9:50am CDT

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Pylorus preserving pancreaticoduodenectomy for peri-ampullary carcinoma, is it a good option?

Saudi J Gastroenterol. 2010 Apr-Jun;16(2):75-8

Authors: Alsaif F

Pancreaticoduodenectomy (PD) is the standard surgical treatment for resectable peri-ampullary tumors. It can be performed with or without pylorus preservation. Many surgeons have a negative opinion of pylorus preserving PD (PPPD) and consider it an inferior operation, especially from an oncological point of view. This article reviews the various aspects of PD in the context of operative factors like blood loss and operation time, complications such as delayed gastric emptying and anastomotic leaks, and the impact on quality of life and survival. We aim to show that PPPD is at least as good as classic PD, if not better in some aspects.

PMID: 20339174 [PubMed - indexed for MEDLINE]
Lymph node involvement and not the histophatologic subtype is correlated with outcome after resection of adenocarcinoma of the ampulla of vater.

Fetched: June 26th, 2010, 9:50am CDT

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Lymph node involvement and not the histophatologic subtype is correlated with outcome after resection of adenocarcinoma of the ampulla of vater.

J Gastrointest Surg. 2010 Apr;14(4):719-28

Authors: de Paiva Haddad LB, Patzina RA, Penteado S, Montagnini AL, da Cunha JE, Machado MC, Jukemura J

BACKGROUND: Intestinal and pancreaticobiliary types of Vater's ampulla adenocarcinoma have been considered as having different biologic behavior and prognosis. The aim of the present study was to determine the best immunohistochemical panel for tumor classification and to analyze the survival of patients having these histological types of adenocarcinoma. METHOD: Ninety-seven resected ampullary adenocarcinomas were histologically classified, and the prognosis factors were analyzed. The expression of MUC1, MUC2, MUC5AC, MUC6, CK7, CK17, CK20, CD10, and CDX2 was evaluated by using immunohistochemistry. RESULTS: Forty-three Vater's ampulla carcinomas were histologically classified as intestinal type, 47 as pancreaticobiliary, and seven as other types. The intestinal type had a significantly higher expression of MUC2 (74.4% vs. 23.4%), CK20 (76.7% vs. 29.8%), CDX2 (86% vs. 21.3%), and CD10 (81.4% vs. 51.1%), while MUC1 (53.5% vs. 82.9%) and CK7 (79.1% vs. 95.7%) were higher in pancreatobiliary adenocarcinomas. The most accurate markers for immunohistochemical classification were CDX2, MUC1, and MUC2. Survival was significantly affected by pancreaticobiliary type (p = 0.021), but only lymph node metastasis, lymphatic invasion, and stage were independent risk factors for survival in a multivariate analysis. CONCLUSION: The immunohistochemical expression of CDX2, MUC1, and MUC2 allows a reproducible classification of ampullary carcinomas. Although carcinomas of the intestinal type showed better survival in the univariate analysis, neither histological classification nor immunohistochemistry were independent predictors of poor prognosis.

PMID: 20107918 [PubMed - indexed for MEDLINE]

Combination Chemotherapy Improves Survival in Biliary Tract Cancer
Medscape
... and patients with recurrent or advanced biliary cancer (including intrahepatic or extrahepatic biliary cancer, cholangiocarcinoma, and ampullary cancer) ...

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