Carcinoma of the ampulla of Vater: review of 38 cases with emphasis on treatment and prognostic factors

Thirty eight cases of carcinoma of the ampulla of Vater are presented. The diagnosis has been confirmed at laparotomy in all patients. Three operations were done, a pancreaticoduodenal resection in 23 patients, a biliary enteric bypass in 7 patients and a biliary enteric bypass plus excision of tumor in 8 patients. The operative mortality was 8% following resection, 14% following bypass plus excision of the ampulla and 13% following biliary enteric bypass. Five patients survived 5 or more years. The longest survivors have followed pancreaticoduodenal resections (131 and 216 months). The level of bilirubin or presence of pain did not correlate with prognosis. Prognosis was better in the absence of nodal metastases, and in the presence of papillary tumors.