We reviewed the medical records of 55 patients who underwent Whipple resection for adenocarcinoma of the ampulla of Vater at UCLA Medical Center between October 14, 1988, and July 24, 2001. Tumor origin was confirmed through microscopic histologic analysis, and only patients with ampullary adenocarcinoma were included. Patients with ampullary adenoma, ampullary fibrosis, adenosquamous carcinoma, carcinosarcoma, or other unusual tumors of the ampulla were excluded from this analysis. Follow-up data were obtained through medical record review, direct patient contact, and through United States Social Security record examinations. The review included patient demographics (age, sex, race, and date of diagnosis), symptoms on initial examination (jaundice, pain, gastrointestinal bleeding, and pancreatitis), surgical data (type of resection, operative blood loss, duration of surgery, transfusion requirement, and perioperative complications), tumor characteristics (size, degree of differentiation, depth of invasion, surgical margin status, perineural invasion, lymphovascular invasion, and lymph node involvement), and use of adjuvant chemotherapy and/or radiotherapy. For postoperative morbidity analysis, delayed gastric emptying was defined as intolerance to oral intake and need for nasogastric decompression following postoperative day 7, as well as slow transit of contrast from the stomach to the jejunal limb demonstrated on upper gastrointestinal radiographic contrast examination. In addition, a pancreatic fistula was defined as drainage of greater than 30 mL of amylase-rich fluid (at least 3 times the serum amylase concentration) from intraoperatively placed closed-suction drains after the fifth postoperative day.