Prognostic significance of extracapsular lymph node involvement in patients with adenocarcinoma of the ampulla of Vater

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. Methods: In a consecutive series of 160 patients with adenocarcinoma of the ampulla of Vater, 75 (46.9 per cent) had positive lymph nodes (NI). 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 (NO). Extracapsular LNI and tumour differentiation were independent prognostic factors for survival. In patients with NI 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.