Importance of Lymph Node Metastasis to the Pancreatic Head Region in Patients with Ampulla of Vater Carcinoma

Introduction: Owing to their rarity, clinicopathologic variables and postoperative outcomes in patients with ampulla of Vater carcinoma (AVC) have not been fully elucidated. Materials and Methods: A retrospective review of the clinical records of patients who underwent surgical exploration for AVC was performed using univariate and multivariate analyses. Results: One-, three-, and five-year overall survival rates after surgery were 97.4%, 71.8%, and 63.0%, respectively. The most frequently observed sites of recurrence were lymph nodes in 11 patients (52%), followed by the liver in eight (38%), lung in six (29%), local in three (14%), and peritoneal dissemination in three (14%). On multivariate analysis, only the presence of lymph node metastasis extending to the pancreatic head region predicted inferior relapse-free survival. A significant correlation between postoperative recurrence and pathological lymph node metastasis was observed. Conclusions: Lymph node metastasis, especially that extends to the pancreatic head region, was clearly identified as a prognostic indicator of reduced relapse-free survival in patients with AVC.