Role of adjuvant chemotherapy on recurrence and survival in patients with resected ampulla of Vater carcinoma

BACKGROUND Owing to rarity of disease and lack of prospective studies, data supporting the role of adjuvant chemotherapy in ampulla of Vater(AoV) carcinoma is limited.AIM To evaluate whether adjuvant chemotherapy cases for AoV carcinoma had better disease-free survival(DFS) rates than cases of observation following curative surgery.METHODS We retrospectively analyzed the association between adjuvant chemotherapy and DFS and overall survival(OS) in patients with stage IB-Ⅲ AoV carcinoma who underwent curative surgical resection. Fluorouracil-based adjuvant chemotherapy was administered after surgery at the discretion of the physician. Adjusted multivariate regression models were used to evaluate the association between adjuvant chemotherapy and survival outcomes.RESULTS Of the total 104 patients who underwent curative surgery, 52 received adjuvant chemotherapy. Multivariate analysis revealed that higher histologic grade [hazard ratio(HR) = 2.24, P = 0.046], advanced tumor stage(HR = 1.85, P = 0.030), and vascular invasion(HR = 2.14, P = 0.010) were associated with shorter DFS. Adjuvant chemotherapy improved DFS compared to the observation group(HR =0.50, P = 0.015) and tended to be associated with a longer OS, although the difference was not statistically significant(HR = 0.58, P = 0.098).CONCLUSION Among patients with resected AoV carcinoma, the adjuvant chemotherapy group was not associated with a significant survival benefit compared to the observation group. However, on multivariate analysis adjusting for prognostic factors, adjuvant chemotherapy following surgery was an independent prognostic factor for DFS in patients with resected AoV carcinoma. Further studies are needed to investigate the effectiveness of adjuvant chemotherapy according to histologic phenotype.

KL-6 mucin expression in carcinoma of the ampulla of Vater: Association with cancer progression

AIM： To assess histochemical expression of KL-6 and its clinicopathological significance in carcinoma of the ampulla of Vater. METHODS： Ampullary carcinoma tissues were collected from 38 patients who underwent pancreatoduodenectomy or local resection. Tissues were subjected to immunohistochemical analysis using KL-6 antibody. RESULTS： Positive staining of ampullary carcinoma cells was observed in 26 （68.4%） cases. Staining was not found in the surrounding non-cancer regions of the ampullary tissues. Remarkable KL-6 expression was observed in invasive carcinoma cells in pancreatic and duodenal tissues and in metastatic carcinoma cells in lymph nodes. Positive KL-6 expression was related to lymph node metastasis （P = 0.020）, pancreatic invasion （P = 0.016）, duodenal invasion （P = 0.034）, and advanced stage of TNM clinical classification （P = 0.010）. Survival analysis showed that positive expression of KL-6 was related to a poorer prognosis （P = 0.029）. CONCLUSION： The aberrant expression of KL-6 mucin is significantly related to unfavorable behaviors of cardnoma of the ampulla of Vater.

A rare case of periampullary carcinoma with ectopic ending of Vater's ampulla

A 71-year-old woman was referred to our department complaining of painless progressive jaundice for the last 3 too. Magnetic resonance imaging and magnetic resonance cholangiopancreatography （MRCP） showed the ectopic hepatopancreatic ampulla draining into the fourth part of the duodenum adjacent to the duodenojejunal flexure; the irregular morphology of the duodenojejunal flexure likely due to a soft tissue mass. Laparotomy confirmed the presence of the abnormal ampulla of Vater located at the fourth part of the duodenum and a soft tissue tumor about 6 cm × 5 cm×5 cm with a peduncle adjoining the ampulla. Resection of the tumor, including some peripheral tissue, and a Roux-Y loop anastomosis choledochojejunostomy were performed. Pathological examination indicated an intestinal villous adenoma accompanied by severe dysplasia and focal canceration. Periampullary carcinoma with ectopic ending of the Vater＇s ampulla into the fourth part of the duodenum is rather rare. The embryonic genetic background of this anomaly has not yet been fully explained. It is worth mentioning that MRCP is useful for demonstrating anomalies and anatomic variants of the biliary tract system and pancreatic duct.

Prognostic relevance of number and ratio of metastatic lymph nodes in resected carcinoma of the ampulla of Vater

Objectives： To explore the prognostic relevance of the number and ratio of metastatic lymph nodes in resected Carcinoma of the ampulla of Vater （CAV）. Methods： The clinical data of 155 patients who underwent pancreaticoduodenectomy （PD） for cancer of the ampulla of Vater between January 1990 and December 2010 were retrospectively analyzed. Kaplan- Meier method was used in survival analysis and Log rank method in comparison. Multivariate analysis was performed using Cox proportional hazards model. Results： Among these 155 patients, the in-hospital mortality rate was 4.5%, lymph node positive disease was 21.3%, and the 5-year survival rate was 51.6%. Patients with a lymph node ratio （LNR） 〉20% were more likely to have tumor differentiation, depth of duodenal involvement, depth of pancreatic invasion, T-stage and TNM-Stage. The number of the metastatic lymph nodes is important prognostic factors of the CAV. Univariate analysis showed that the factors associated with the prognosis included tumor size （P=0.036）, tumor differentiation （P=0.019）, LNR （P=0.032）, mtmber of metastatic lymph nodes （P=0.024）, lymph node metastasis （P=0.03）, depth of pancreatic invasion （P=0.001）, T-stage （P=0.002）, TNM stage （P=0.001）, elevated CA 19-9 （P=0.000）, and jaundice （P=0.021）. Multivariate analysis showed that the factors associated with the prognosis were the number of metastatic lymph nodes （P=0.032; RR： 1.283; 95% CI： 1.022-1.611）, tumor size （P=0.043; RR： 1.736; 95% CI： 1.017-2.963）, and elevated CA 19-9 （P=0.003; RR： 3.247; 95% CI： 1.504-7.010）. Conclusions： LNR is a useful factor for predicting the prognosis of the radical treatment for CAV,, whereas the number of metastatic lymph nodes is the most important factor. Further research on the locations, number, and LNR will be clinically meaningful to improve survival in patients with CAV.

Large cell neuroendocrine carcinoma of the ampulla of Vater

BACKGROUND: Neuroendocrine tumors of the ampulla of Vater are extremely rare, and few cases of large cell neuroendocrine carcinoma (LCNEC) of the ampulla have been reported. METHODS: A 48-year-old male with obstructive jaundice was admitted to our hospital. On examination the patient was found to have a periampullary growth and subsequently underwent the Whipple's procedure. RESULTS: Histopathological examination and immunohistochemistry revealed features of LCNEC of the ampulla of Vater. The patient developed multiple liver metastases 6 months after Whipple's procedure. CONCLUSION: LCNEC of the ampulla of Vater is rare and highly aggressive, with a dismal prognosis.

Signet Ring Cell Carcinoma of Ampulla of Vater: Report of a Rare Malignancy and Literature Review

Introduction: Signet ring cell carcinoma is a rare tumor that generally originates in the gastrointestinal tract. Signet-ring cell carcinoma of the ampulla of Vater is extremely uncommon and a very rare clinical entity, which is infrequently reported in medical literature and only 31 cases have been mentioned. Most tumors affecting Vater’s Ampulla are adenocarcinomas and other histological variants are less frequent. It mainly occurs in elderly patients. Case Presentation: We report a case of signet ring cell carcinoma of Vater’s Ampulla. The tumour had infiltrated the duodenal, but local lymph nodes were clear (T3N0M0). Duodenopancreatectomy with pylorus preservation is the treatment of choice. Conclusions: Etiology and survival are not well-defined in the literature due to the extreme rarity of this disease.

Vater壶腹病变多层螺旋CT诊断分析

目的探讨多层螺旋CT(Multislice CT,MSCT)对Vater壶腹病变的临床诊断价值。方法回顾分析21例病理证实Vater壶腹病变的MSCT表现。结果本组21例患者中,壶腹部软组织密度影占71.4%(15/21);胆总管扩张占90.5%(19/21),平均直径(1.59±0.50)cm;胰管扩张占76.2%(16/21),平均直径(0.61±0.37)cm;出现双管征占66.7%(14/21)。病变来源于壶腹、十二指肠、胆管分别为13例、6例、2例。十二指肠来源者壶腹部见软组织密度影显示率83.3%(5/6);壶腹来源病变胆总管扩张、胰管扩张程度高于十二指肠来源病变。结论 MSCT对壶腹部病变的定位、定性诊断可提供一定依据,对临床治疗方案具有重要价值。

Vater壶腹癌局部切除术后长期存活相关因素的分析

目的:探讨影响Vater壶腹癌行局部切除术后长期生存的相关因素,从而制订出更具针对性的治疗方案。方法:回顾性分析行局部切除术的21例Vater壶腹癌患者的临床资料,采用Kaplan-Meier法进行生存分析,独立样本t检验、Fisher精确检验。结果:全组无手术死亡,总的5年生存率为34.1%;15例患者术后出现明确的肿瘤复发和转移,其中10例患者(47.6%)出现局部复发,4例患者(19.0%)出现肝转移,1例患者(4.8%)出现腹壁转移;单因素分析表明,肿瘤直径、肿瘤分化程度是影响Vater壶腹癌患者术后生存时间的相关因素(P=0.014,0.015)。结论:Vater壶腹癌行局部切除术后预后良好,肿瘤直径和肿瘤分化程度是影响预后的相关因素,该术式适用于肿瘤直径<2cm、高分化、T1和T2期患者。

Vater壶腹癌行胰十二指肠切除术后复发的危险因素分析

目的探讨影响Vater壶腹癌胰十二指肠切除术后复发的危险因素，进一步指导临床治疗。方法回顾性分析我院1997年1月～2005年9月间收洽的行胰十二指肠切除术的77例Vater壶腹癌患者的临床资料，采用独立样本t检验、x2检验进行统计学比较，应用Logistic回归模型进行多因素分析Vater壶腹癌切除术后复发的危险因素。结果30例患者术后出现肿瘤复发和／或转移，单因素分析表明，肿瘤直径（P=0．008）、肿瘤侵润深度（P=0．003）、淋巴结转移情况（P=0．039）、TNM分期（P=0．027）、肿瘤分化情况（P=0．019）是影响Vater壶腹癌患者术后复发的危险因素；多因素回归分析显示肿瘤直径（P=0．032）、肿瘤分化情况（P=0．027）是有统计学意义的独立预后指标。结论Vater壶腹癌行胰十二指肠切除术后复发方式以远处转移为主；肿瘤直径、肿瘤分化情况是影响预后的独立相关因素。

Vater氏壶腹癌的CT诊断

目的 :探讨Vater氏壶腹癌的CT诊断价值。方法 :对我院经手术病理证实、CT资料完整的 30例Vater氏壶腹癌进行回顾性分析。其中 2 7例行Whipple手术 ,3例行姑息术作内或外引流。检查前 30min、5min分别口服 1%～ 2 %有机碘造影剂 5 0 0ml。常规上腹部CT平扫 +增强扫描 ,梗阻段、兴趣区作 2mm或 5mm薄层扫描。结果 :壶腹部软组织肿块 ,十二指肠腔内充盈缺损及局部肠粘膜破坏 ,壶腹段胆总管壁不规则增厚、偏心性软组织肿块和肝内、外胆管中、高度扩张 ,胆总管全段扩张 ,胆囊增大 ,双管征是Vater氏壶腹癌的直接和间接CT征象。结论 :CT能清晰显示壶腹癌的直接和间接征象。直接征象的显示与检查方法、扫描技术、CT设备有关 ,CT是诊断壶腹癌有效、准确的检查方法。

Vater壶腹腺鳞癌1例报告

1病例资料患者男性,60岁,因'皮肤巩膜黄染5 d'于2018年2月1日就诊于吉林大学第一医院。病程中患者伴乏力,尿色加深,大便未见异常,无腹部胀痛、发热、恶心呕吐、腹泻、黑便等不适。既往:吸烟史40年,约10支/d,未戒烟;否认结核、肝炎病史,否认家族遗传病史;查体:体温36. 8℃,脉搏72次/min,呼吸20次/min,血压130/85 mm Hg,皮肤巩膜黄染.

Jaundice as a prognostic factor in patients undergoing radical treatment for carcinomas of the ampulla of Vater

Background Carcinomas of the ampulla of Vater （CAV） is a relatively rare malignant gastrointestinal tumor,and its postoperative prognostic factors have been well studied.However,as its first symptom,the impact of jaundice on the prognosis of CAV is not so clear.This study aims to explore the role of jaundice as a prognostic factor in patients undergoing radical treatment for CAV.Methods The clinical data of 195 patients with CAV who were treated in the Cancer Hospital,Chinese Academy of Medical Sciences ＆ Peking Union Medical College,from January 1989 to January 2013 were retrospectively analyzed.Among them,170 patients with pathologically confirmed CAV entered the statistical analysis.Jaundice was defined as a total bilirubin serum concentration of ≥3 mg/dl.Result Of these 170 patients,99 （58.20％） had jaundice at presentation.Jaundice showed significant correlations with tumor differentiation （P=0.002）,lymph node metastasis （P=0.016）,pancreatic invasion （P=0.000）,elevated preoperative CA199 （P=0.000）,depth of invasion （P=0.000）,and tumor stage （P=0.000）.There were more patients with pancreatic invasion in the jaundice group than in the non-jaundice group.Also,lymph node metastasis was more common in the jaundice group （n=26） than in the non-jaundice group （n=8）.The non-jaundice group had significant better overall 5-year disease-free survival （72.6％） than the jaundice group （41.2％,P=0.013）.Jaundice was not significantly correlated with the postoperative bleeding （P=-0.050）.Conclusions Jaundice in patients with CAV often predicts more advanced stages and poorer prognoses.Pancreatic invasion and lymph node metastasis are more common in CAV patients with jaundice.Jaundice is not a risk factor for postoperative bleeding and preoperative biliary drainage cannot reduce the incidence of postoperative complications.

超声结合血清学指标在壶腹癌与胰头癌鉴别诊断中应用

目的探讨超声与血清学检查联合应用在壶腹癌与胰头癌鉴别诊断中的价值。方法选择2013年2月至2018年10月在福建医科大学附属协和医院住院手术经病理检查证实的壶腹癌49例,其中男性29例,女性20例;年龄39~77岁,平均年龄59.1岁。经病理检查证实胰头癌63例,其中男性38例,女性25例,年龄35~79岁,平均年龄60.6岁。外科手术前1周内行腹部超声检查和血液肿瘤标记物Ca19-9、血生物化学检查[总胆红素(TBiL)、直接胆红素(DBiL)、天冬氨酸转氨酶(AST)、碱性磷酸酶(ALP)],分析两组患者的血清学指标和超声声像图特征。结果壶腹癌与胰头癌均多见于中老年男性,胰头癌组Ca19-9>200 U/mL所占比率高于壶腹癌组,而壶腹癌组TBiL、DBiL、AST、ALP测值升高的比率高于胰头癌组。壶腹癌组病灶平均最大径(2.42 cm)小于胰头癌组(3.92 cm),壶腹癌组发生肝内外胆管扩张的比率(95.9%)高于胰头癌组(69.8%)。壶腹癌与胰头癌多呈较均质的低回声病灶,乏血液供应,但胰头癌病灶形态更不规则,边界不清,常侵犯周围血管组织。术前超声对壶腹癌与胰头癌的诊断准确率分别为46.94%、100.00%。结论壶腹癌与胰头癌在超声表现与血液学指标方面存在一定的差异,超声检查时应综合分析判断,对于提高术前诊断率,为临床制定诊疗方案具有重要意义。

AFP阳性胰腺癌和壶腹乳头部癌的临床病理研究

目的:研究AFP阳性胰腺癌(4例)和壶腹乳头部(1例)癌的临床病理特征.方法:收集并分析5例此癌患者的临床资料,对其病理标本应用光镜、免疫组织化学进行研究.结果;此类癌多见于中老年人,血清AFP明显增高;5例均发生肝转移,于1年内死亡,平均生存期5个月;病理组织形态:均为浸润性癌,脉管内常见癌栓;2例为分化差腺癌,2例为肝样腺癌(1例为壶腹乳头部,1例为胰腺),后者癌组织由两种不同而又密切相关的腺癌区和肝样分化区组成,肝样区癌细胞具有与肝细胞癌相类似的形态特征,其癌细胞AFP染色呈阳性表达.结论:此类癌由于AFP具有免疫抑制作用,癌细胞侵袭性强易发生肝转移,病人预后不良,属高度恶性肿瘤.

壶腹周围癌合并糖尿病患者的围手术期处理

目的 探讨壶腹周围癌合并糖尿病患者的围手术期处理方法。方法 回顾性总结１９９６～１９９８ 年收治的２９ 例壶腹周围癌合并糖尿病患者的临床资料。结果 全部病例均手术治疗，其中胰十二指肠切除术１９ 例，均严格按糖尿病处理，术前血糖控制在５．３～７．６ｍ ｍ ｏｌ／ Ｌ。围手术期疗效满意率为１００％ ，无手术死亡。结论 加强围手术期的处理可提高壶腹周围癌合并糖尿病患者的手术耐受性，降低术后并发症。

胰头癌和壶腹癌的淋巴结转移及病理特点分析

目的:探讨胰头癌和壶腹癌的淋巴结转移及病理特点。方法:回顾性分析201例胰头癌和壶腹癌根治手术后的淋巴结转移及病理特点,χ2检验分析淋巴结转移与病理因素的相关性。结果:201例胰头癌和壶腹癌行胰十二指肠切除术,淋巴结转移率分别为32.65%(16/49),30.92%(47/152),其转移淋巴结累及部位基本相同,其中88.89%(32/36)单个淋巴结转移位于胰十二指肠周围。χ2检验显示壶腹癌淋巴结转移相关的病理因素有:肿瘤直径(P=0.002),肿瘤分化程度(P=0.012),十二指肠壁浸润(P=0.008),T分期(P=0.000),胰腺受侵(P=0.005),胰头癌与上述病理因素无关,但神经浸润比例高。结论:胰头癌的淋巴结转移及病理特点与壶腹癌有所不同,手术方式的应有所区别,胰头癌应行扩大根治性手术切除。

十二指肠壶腹部神经内分泌癌的诊断与治疗（附七例报告）

目的 探讨十二指肠壶腹部神经内分泌癌临床病理学特征、诊断和治疗方法.方法 回顾分析7例十二指肠壶腹部神经内分泌癌病例并结合文献,综合分析十二指肠壶腹部神经内分泌癌的临床病理学特征、诊断及治疗.结果 7例十二指肠壶腹部神经内分泌癌占同期十二指肠壶腹部肿瘤的4.32%（7/162）.主要临床症状为腹痛、梗阻性黄疸、消化道出血和贫血.术前影像学检查是诊断十二指肠壶腹部肿瘤的主要手段,其中1例患者在术前经内镜及内镜超声确诊.经组织病理及免疫组化诊断为大细胞神经内分泌癌3例、小细胞神经内分泌癌3例,不典型类癌1例.其中行胰十二指肠切除术5例,行十二指肠乳头部肿瘤局部切除术2例.所有患者均得到随访.全组中位生存期为23个月.结论 十二指肠壶腹部神经内分泌癌罕见.针对十二指肠壶腹部高级别神经内分泌癌进行根治性切除可能改善患者的预后.

磁共振胆胰管成像对壶腹部肿瘤诊断的价值

目的 评价磁共振胆胰管成像对壶腹部癌的诊断价值。方法 通过总结 2 3例壶腹部癌的 MRCP及 MRI影像资料 ,对磁共振影像诊断与病理学诊断的符合率进行回顾性分析。结果 磁共振胆胰管成像的定位诊断率为 10 0 % ,与病理诊断的符合率也达 91.3%。结论 磁共振胆胰管成像是一种非介入性胆胰管成像技术 ,具有不需要对比剂、无创伤及图像清晰的优点。

架桥式内引流治疗晚期壶腹周围癌

目的 探讨手术解除晚期壶腹周围癌致阻塞性黄疸的可行方法。方法 在 11例手术不能切除的晚期壶腹周围癌病人的胆总管置入 18号T型管 ,T型管的另一端插入十二指肠约 10cm ,包埋、固定。使T型管在胆总管与十二指肠之间 ,形成一个“架桥式”结构。然后行胃空肠吻合和空肠与空肠的侧侧吻合 ,并与单纯剖腹探查组病人比较。结果 该组病人术后 6个月生存率为 72 .7%(8/ 11) ,9个月生存率为 4 5 .5 % (5 / 11) ,12个月生存率为 9% (1/ 11) ;单纯剖腹探查组病人术后 6个月生存率为 11.1% (1/ 9) ,9个月生存率为 0。结论 该手术方法简单、安全 ,可用于多种原因造成恶性阻塞性黄疸的病人 ,且费用低廉适合于我国国情 ,值得进一步推广。

超声对壶腹癌诊断价值及检查方法的探讨

目的总结壶腹癌的声像图特征,探讨提高其显示率的方法。方法对我院超声诊断并经手术或CT证实的23例壶腹癌的声像图进行回顾性分析总结,扫查时对胆总管扩张者按常规追踪胆总管至壶腹部,显示不清者令患者一次饮水500ml以上,采取不同的体位,仔细观察胆总管下段、胰头及充盈的十二指肠壶腹,必要时令患者深呼吸、局部加压或咳嗽,动态观察病变部位及其与以上三者的关系。结果1.饮水后右侧卧位比平卧位、坐位图像清晰,配合深呼吸、咳嗽,动态观察有意义。2.壶腹癌声像图分以下四型团块型11例(48%);乳头型3例(13%);厚壁狭窄型5例(22%);末端堵塞型2例(9%);2例仅显示胆管全程扩张型,未见明显占位病灶。结论超声检查并辅以简便易行的辅助方法能较好地显示壶腹癌及其与周围结构的关系,是壶腹癌诊断重要的检查手段。