[Treatment concept of adenomas of Vater's ampulla].
BACKGROUND
The most common benign ampullary tumors are adenomas (80%). They are considered as premalignant lesions with a transformation rate to carcinoma of up to 30%.


METHODS
From 1 January 1997 to 28 February 1999 we treated 11 patients with adenoma of the ampulla of Vater. An ampullectomy was performed in 10 cases. One poor-risk patient could not be operated on.


RESULTS
No operative mortality occurred. In two patients a pT1 adenocarcinoma was diagnosed postoperatively. One of the two patients with a high-risk carcinoma underwent a second operation, a Whipple pancreatoduodenectomy. Nine of 10 patients had no recurrence with a median follow-up of 12 months.


CONCLUSIONS
One patient died of glioblastoma. We would therefore recommend ampullectomy as the first-line treatment for benign tumors of the ampulla of Vater. In low-risk pT1 carcinoma (G1/G2, L0) and R0 resection, local excision is acceptable. In high-risk pT1 carcinoma (G3 and/or L1) Whipple pancreatoduodenectomy is mandatory.
Witzigmann
H
H
Klinik für Abdominal-, Transplantations- und Gefässchirurgie, Universität Leipzig. with@medizin.uni-leipzig.de
Möbius
C
C
Uhlmann
D
D
Geissler
F
F
Tannapfel
A
A
Halm
U
U
Hauss
J
J
D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery; D000236:Adenoma / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D014670:Ampulla of Vater / Q000473:pathology / Q000601:surgery*; D003135:Common Bile Duct / Q000473:pathology / Q000601:surgery; D003138:Common Bile Duct Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000601:surgery; D016577:Pancreaticoduodenectomy; D011183:Postoperative Complications / Q000473:pathology / Q000601:surgery; D011230:Precancerous Conditions / Q000473:pathology / Q000601:surgery*