Importance of microperineural invasion as a prognostic factor in ampullary carcinoma

This was a study of the relation of clinicopathological factors to prognosis in 25 patients who had ampullary carcinoma resected.The 5-year survival rate was six of the 25 patients. The presence of microperineural invasion was sought and related to outcome.Factors relating to prognosis included tumour gross appearance, diameter, pancreatic invasion and microperineural invasion. The 5-year survival rate of 14 patients with microperineural invasion was 3, significantly worse than the 7 in 11 without invasion (P = 0.002, univariate analysis). By multivariate analysis, microperineural invasion was the most important prognostic factor (P = 0.02). Type of tumour recurrence was similar to that in pancreatic carcinoma.Pancreaticoduodenectomy, rather than local resection, is the procedure of choice in patients with ampullary carcinoma.