Clinicopathological characteristics and surgical procedures for carcinoma of the papilla of Vater.
OBJECTIVE
In the present study, clinicopathological characteristics of carcinoma of the papilla of Vater and suitable operative procedures for treatment were investigated.


METHODS
Sixty cases (40 male and 20 female) of resected carcinoma of the papilla of Vater were studied clinicopathologically.


RESULTS
Among the patients, a polypoid type without ulceration and an ulcer-formation type, with regard to the gross appearance, were found in 37 cases and 23 cases, respectively. Submucosal invasion, invasion to the sphincter Oddi, pancreatic parenchymal invasion and lymph node involvement were found more frequently in the ulcer-formation type than in the polypoid type without ulceration. Postoperative survival curves revealed that the prognosis was poor when either lymph node involvement, invasion to pancreatic parenchyma or ulcer formation was found. Local resection was performed in seven cases, in all of whom carcinoma was found histologically in the cut surface of the tumor. This is easily explained by the fact that mucosal spread or interstitial infiltration was frequently found even in cases with carcinoma at a relatively early stage.


CONCLUSIONS
Local resection for carcinoma of the papilla of Vater is inadequate as a curative resection, and pylorus-preserving pancreatoduodenectomy should be the treatment of choice for carcinoma of the papilla of Vater. However, since there were no differences between the postoperative survival curves of patients who underwent pancreatoduodenectomy or local resection, local resection may still be suitable for patients with other major diseases or a poor condition.
Futakawa
N
N
First Department of Surgery, Faculty of Medicine, the University of Tokyo, Japan.
Kimura
W
W
Wada
Y
Y
Muto
T
T
D000328:Adult; D000368:Aged; D014670:Ampulla of Vater; D002277:Carcinoma / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D003138:Common Bile Duct Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D010179:Pancreas / Q000473:pathology; D016577:Pancreaticoduodenectomy; D011127:Polyps / Q000473:pathology; D011379:Prognosis; D009803:Sphincter of Oddi / Q000473:pathology