Transduodenal excision of tumours of the ampulla of Vater.
OBJECTIVE
To evaluate the symptoms, diagnostic procedures, and treatment by transduodenal excision, of tumours in the ampulla of Vater.


METHODS
Open study of consecutive patients.


METHODS
University hospital, Denmark.


METHODS
Six patients with tumours in the ampulla of Vater.


METHODS
Ultrasonography, duodenoscopy, and endoscopic retrograde cholangiopancreatography (ERCP). Endoscopic biopsy if tumour was visible at the papilla. Transduodenal excision of the ampulla and anastomoses of the common duct and pancreatic duct to the duodenum.


METHODS
Postoperative complications and survival.


RESULTS
None of the tumours could be seen on ultrasonography. All the tumours were diagnosed on duodenoscopy with ERCP. The histopathological diagnoses of the endoscopic biopsy specimens were adenoma (n = 3), suspicion of adenocarcinoma (n = 2), and adenocarcinoma (n = 1). Curative resection by transduodenal excision of the ampulla of Vater was possible in all cases. Pathological examination of the surgical specimens showed three adenomas and three adenocarcinomas. One patient had a recurrence after 2.5 years and had a further resection. Three patients died after one, three, and nine years, respectively; two had no recurrence and one was suspected of having one. The other three patients were alive 8-20 months after the operation.


CONCLUSIONS
The procedure is recommended for small and probably benign tumours and, when technically possible, in malignant tumours in patients at high operative risk. Close postoperative follow-up with duodenoscopy and ERCP is recommended.
Alstrup
N
N
Department of Gastrointestinal Surgery, Herlev Hospital, University of Copenhagen, Denmark.
Burcharth
F
F
Hauge
C
C
Horn
T
T
D000236:Adenoma / Q000175:diagnosis / Q000601:surgery*; D018195:Adenosarcoma / Q000601:surgery; D000368:Aged; D000369:Aged, 80 and over; D014670:Ampulla of Vater / Q000601:surgery*; D003138:Common Bile Duct Neoplasms / Q000175:diagnosis / Q000601:surgery*; D004386:Duodenum / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013514:Surgical Procedures, Operative / Q000379:methods; D016896:Treatment Outcome