Compared with carcinoma of the body and tail of the pancreas, carcinoma of the ampulla of Vater carries a substantially better prognosis after resection. The main reason is that ampullary tumours:

• A Are almost always mucinous and therefore chemosensitive
• B Cause obstructive jaundice early, leading to diagnosis at a smaller size and lower stage ✓
• C Rarely metastasise to lymph nodes because of absent lymphatics at the ampulla
• D Are more often resected by distal pancreatectomy, a safer operation than the Whipple procedure

Explanation

Because the ampullary tumour obstructs the common bile duct while still small, patients present early with painless jaundice, permitting resection at low stage with 5-year survival around 30 to 50 percent, far better than pancreatic ductal adenocarcinoma. Lymph node metastasis is common in ampullary cancer and is a major prognostic factor, so option C is false. Ampullary tumours require pancreaticoduodenectomy, not distal pancreatectomy, since the duodenum must be removed.

Reference: Sabiston Textbook of Surgery, 21st ed.

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Written and medically reviewed by the StethoPrep medical team.