PMID- 17968172
OWN - NLM
STAT- MEDLINE
DCOM- 20071219
LR  - 20131121
IS  - 0003-4932 (Print)
IS  - 0003-4932 (Linking)
VI  - 246
IP  - 5
DP  - 2007 Nov
TI  - Liver perfusion chemotherapy for selected patients at a high-risk of liver 
      metastasis after resection of duodenal and ampullary cancers.
PG  - 799-805
AB  - OBJECTIVE: To evaluate the prognostic benefit of postoperative liver perfusion 
      chemotherapy (LPC) in patients who undergo curative resection of duodenal and 
      ampullary cancers. SUMMARY BACKGROUND DATA: Both nodal involvement and pancreatic 
      invasion are poor prognostic indicators after curative resection of ampullary or 
      duodenal cancers due to high incidences of liver metastasis. Therefore, we have 
      performed postoperative LPC on a number of such "high-risk" patients. METHODS: 
      During the period of 1990 to 2005, 72 consecutive patients successfully underwent 
      curative (R0) resection of duodenal or ampullary carcinomas at our institution, 
      The Osaka Medical Center for Cancer and Cardiovascular Diseases. Of these 72 
      patients, 38 were found to have positive nodal involvement and/or pancreatic 
      invasion based on an intraoperative inspection, and of these, 28 were deemed to 
      be suitable candidates for intraoperative catheterization: 1 catheter was placed 
      into the gastroduodenal artery; another into the portal vein (group A). 
      Postoperatively, they received an infusion of 5-fluorouracil (5-FU: 125 mg/d) via 
      each of the 2 catheters for a period of 28 continuous days. The remaining 44 
      patients (group B) did not receive any other adjuvant therapy. The survival rates 
      and patterns of disease failure were compared between these 2 groups and their 
      subgroups. RESULTS: All 72 patients survived the operation, and all 28 patients 
      in group A completed their courses of LPC without showing any significant adverse 
      signs. Postoperative histopathology was later performed to get a more accurate 
      picture regarding the degree of nodal involvement and/or pancreatic invasion: In 
      group A, 21 patients (group A1) proved positive for nodal and/or pancreatic 
      invasion whereas 7 patients (group A2) proved negative; and in group B, 16 
      patients proved positive (group B1) whereas 28 proved negative (group B2). 
      Although group A displayed higher incidences of nodal involvement and pancreatic 
      invasion, the 5-year survival rates for the 2 groups varied only slightly. The 
      5-year survival rate was 70% in group A1, 85% in group A2, 35% in group B1, and 
      92% in group B2, respectively. The difference between B1 and B2 and the 
      difference between A1 and B1 were statistically significant, and these 
      differences were conclusively found to be attributable to the different 
      incidences of liver metastasis. CONCLUSION: Through this research, both nodal 
      involvement and pancreatic invasion were confirmed to be reliable predictors of 
      liver metastasis after curative resection of ampullary and duodenal cancers. 
      Since LPC was proven to be effective in preventing the postoperative development 
      of liver metastasis, it should be more actively performed for patients with a 
      high-risk of liver metastasis.
FAU - Noda, Takehiro
AU  - Noda T
AD  - Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular 
      Diseases, Osaka, Japan.
FAU - Ohigashi, Hiroaki
AU  - Ohigashi H
FAU - Ishikawa, Osamu
AU  - Ishikawa O
FAU - Eguchi, Hidetoshi
AU  - Eguchi H
FAU - Yamada, Terumasa
AU  - Yamada T
FAU - Sasaki, Yo
AU  - Sasaki Y
FAU - Yano, Masahiko
AU  - Yano M
FAU - Imaoka, Shihgi
AU  - Imaoka S
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - Ann Surg
JT  - Annals of surgery
JID - 0372354
RN  - 0 (Antimetabolites, Antineoplastic)
RN  - U3P01618RT (Fluorouracil)
SB  - IM
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - *Ampulla of Vater
MH  - Antimetabolites, Antineoplastic/*administration & dosage
MH  - Chemotherapy, Adjuvant
MH  - Common Bile Duct Neoplasms/mortality/pathology/*therapy
MH  - Duodenal Neoplasms/mortality/pathology/*therapy
MH  - Female
MH  - Fluorouracil/*administration & dosage
MH  - Hepatic Artery
MH  - Humans
MH  - Infusion Pumps, Implantable
MH  - Infusions, Parenteral
MH  - Liver Neoplasms/epidemiology/*prevention & control/secondary
MH  - Male
MH  - Middle Aged
MH  - Pancreaticoduodenectomy
MH  - Portal Vein
MH  - Survival Rate
MH  - Treatment Outcome
EDAT- 2007/10/31 09:00
MHDA- 2007/12/20 09:00
CRDT- 2007/10/31 09:00
PHST- 2007/10/31 09:00 [pubmed]
PHST- 2007/12/20 09:00 [medline]
PHST- 2007/10/31 09:00 [entrez]
AID - 00000658-200711000-00017 [pii]
AID - 10.1097/SLA.0b013e318158fc7f [doi]
PST - ppublish
SO  - Ann Surg. 2007 Nov;246(5):799-805. doi: 10.1097/SLA.0b013e318158fc7f.