Introduction : The prognosis for patients with Ampulla of Vater cancer is better than other periampullary cancers. The aim of the present study is to determine the prognostic impact of lymph node metastasis on survival in patients with ampulla of Vater cancer following surgical resection. The impact of metastatic lymph node ratio (LNR) and number of lymph node metastasis on survival was investigated.

Methods : From 1991 to 2016, we identified and reviewed 128 patients with ampulla of Vater cancer retrospectively. Clinicopathologic factors and LNR, number of metastatic lymph nodes influencing survival were statistically analyzed

Results : There were 51 female and 77 male. Pancreaticoduodenectomy was performed in 112 patients. The 5-year survival rates following resection were 57.8%. Mean number of retrieved lymph nodes was 13. Mean number of metastatic lymph nodes was 0.95. In patients with lymph node metastasis(N1), median number of metastatic lymph node was 1. And mean number of LNR was 0.18. LNR greater than 0.2 was a significant prognostic factors for overall survival. The survival of patients with number of metastatic lymph node 0 or 1 demonstrated better survival than patients with metastatic lymph node 2 or more. Univariate analysis for overall survival revealed that differentiation, and pancreatic invasion, lymph node metastasis, T stage were significant prognostic factors for overall survival. Multivariate analysis revealed that tumor differentiation was an independent prognostic factor for survival.

Conclusions : Pattients with LNR greater than 0.2 and positive lymph node metastasis 2 or more had a poorer survival. Tumor differentiation was a significant prognostic factor.