This is the Scientific Surgery Archive, which contains all randomized clinical trials in surgery that have been identified by searching the top 50 English language medical journal issues since January 1998. Compiled by Jonothan J. Earnshaw, former Editor-in-Chief, BJS
Prognostic significance of extracapsular lymph node involvement in patients with adenocarcinoma of the ampulla of Vater. BJS 2008; 95: 735-743.
Published: 25th February 2008
Authors: N. A. van der Gaag, F. J. W. ten Kate, S. M. Lagarde, O. R. C. Busch, T. M. van Gulik, D. J. Gouma et al.
Background
Lymphatic dissemination is an important predictor of survival in patients with adenocarcinoma of the ampulla of Vater. The incidence and clinical consequences of extracapsular lymph node involvement (LNI) in patients who undergo resection are unknown.
Method
In a consecutive series of 160 patients with adenocarcinoma of the ampulla of Vater, 75 (46·9 per cent) had positive lymph nodes (N1). The relation of extracapsular LNI with tumour stage and number of positive nodes was evaluated and its prognostic significance analysed.
Results
Extracapsular LNI was identified in 44 (59 per cent) of the 75 patients. Median overall survival was 30 and 18 months in patients with intracapsular and extracapsular LNI respectively (P = 0·015). The 5‐year overall survival rate was 20 and 9 per cent respectively, compared with 59 per cent in patients without LNI (N0). Extracapsular LNI and tumour differentiation were independent prognostic factors for survival. In patients with N1 disease, extracapsular LNI was the only significant prognostic factor for recurrent disease after radical resection (R0).
Conclusion
The presence of extracapsular LNI identifies a subgroup of patients who have a significantly worse prognosis. Adjuvant therapy is advised following resection in these patients. Copyright © 2008 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
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