A 58-year-old man who underwent Whipple's procedure returns for review. Histology reports a 2 cm periampullary adenocarcinoma arising from the ampulla of Vater, node negative, with clear margins. Compared with a similarly staged adenocarcinoma of the head of pancreas, his five-year survival expectation is best described as:

• A Higher only if adjuvant chemoradiation was omitted
• B Identical, since both are treated by the same operation
• C Lower, because ampullary tumours metastasise earlier
• D Considerably higher, roughly 40 to 50 percent versus under 20 percent for pancreatic head cancer ✓

Explanation

Ampullary carcinomas obstruct the biliary tract early, producing jaundice at a smaller size, and are biologically less aggressive than pancreatic ductal adenocarcinoma. Resected node-negative ampullary cancers achieve approximately 40 to 50 percent five-year survival, whereas node-negative pancreatic head cancer remains below 20 percent despite identical surgery. Early jaundice leading to early diagnosis, not the choice of operation or omission of adjuvant therapy, explains the survival difference.

Reference: Sabiston Textbook of Surgery, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.