Assessment of the Relapse Patterns Following Surgical Resection of Adenocarcinoma of the Ampulla of Vater in a Third Level Care Hospital: A 5 Years Analysis

Research Article | Open Access

Volume 2023 - 2 | Article ID 229 | http://dx.doi.org/10.51521/WJCRCI.2023.220128

Assessment of the Relapse Patterns Following Surgical Resection of Adenocarcinoma of the Ampulla of Vater in a Third Level Care Hospital: A 5 Years Analysis

Academic Editor: John Bose

Received 2023-10-01
Revised 2023-11-02
Accepted 2023-11-05
Published 2023-11-11

Vargas Gismondi A. MD¹, García-Ríos Luis E. MD² , Luna-Castillo Marisol MD³, Medrano-Guzmán Rafael MD⁴, Mantilla-Morales Alejandra MD⁵, García Avila Ana K. MD⁶, Vargas Odar Maria J. UGS.

^1,2,3,4,6Oncology hospital, Surgical Oncology Department, Division of Soft Tissue, Bone and Digestive Tract Tumors, 21^st Century National Medical Center IMSS, Mexico City, Mexico.

⁵Oncology Hospital, Pathology Department, 21^st Century National Medical Center IMSS, Mexico City, Mexico.

UGS Washington and Lee University, Virginia, USA.

Corresponding Author: Vargas Gismondi Alberto M.D. Surgical Oncology Department, Division of Soft Tissue, Bone and Digestive Tract Tumors, Centro Médico Nacional “Siglo XXI” IMSS, Mexico City, 05300,

Citation: Vargas Gismondi A. MD, García-Ríos Luis E. MD, Luna-Castillo Marisol MD, Medrano-Guzmán Rafael MD, Mantilla-Morales Alejandra MD, García Avila Ana K. MD, Vargas Odar Maria J. UGS. (2023) Assessment of the Relapse Patterns Following Surgical Resection of Adenocarcinoma of the Ampulla of Vater in a Third Level Care Hospital: A 5 Years Analysis World J Case Rep Clin Imag. 2023 October-November; 2(2)1-6.

Copyrights © 2023, Vargas Gismondi A. MD. This article is licensed under the Creative Commons Attribution-Non-Commercial-4.0-International-License-(CCBY-NC) (https://worldjournalofcasereports.org/blogpage/copyright-policy). Usage and distribution for commercial purposes require written permission

ABSTRACT

Background: Relapse of adenocarcinoma of ampulla of Vater (CAV) and its presentation after surgery continues to be a main issue and its patterns is unknown in our population.

Objectives: To describe the relapse patterns after radical surgery and to identify the associated risk factors in a mexican population at a Tertiary Care Center.

Methods: Retrospective Study. Patients with CAV who underwent surgery from January 2016 to December of 2020. Relapse: demonstrable disease by means of radiological studies after 3 months of surgery. Main outcomes: patterns of relapse and associated clinical and pathological factors.

Results: 72 patients CAV included. Relapse developed in 50% (36), 21 men (58.3%), mean age 60 years (range, 56.9 to 63), 18 in clinical stage III (50%), the procedure mostly performed: Traverso 29 (80.6%), the mean procedure duration: 353 minutes and surgical mortality 9.7%. Pancreatic fistula 33.3 % of relapse. CAV relapse: Regional lymph node 19.4%, liver metastasis 52.8%, lung metastasis 27.8%. Mean survival in each relapse pattern: pulmonary metastasis 27.5 months, liver metastasis 25.4 months and lymph nodes metastasis 23.6 months with P=0.002 (95% CI). Mean survival for local relapse 23.6 months and for distant relapse 25.9 months (95%, CI), P=0.29. Identified pancreatic fistula as independent risk factor associated with relapse (HR=2.4, 1.16-4.96, P=0.02).

Conclusions: Relapse patterns: liver (52.8%), pulmonar (27.8%) and regional lymph nodes (19.4%) of which regional lymph node relapse seems to have the worst survival prognosis. Pancreatic fistula was related to relapse and survival deterioration. Local or systemic recurrence have similar prognosis.

Keywords: Adenocarcinoma, Ampulla of Vater, Fistula, Metastasis, Prognosis