Long-term outcome after ampullectomy for ampullary lesions associated with familial adenomatous polyposis.
OBJECTIVE
Up to 90 percent of patients with familial adenomatous polyposis develop adenomas in the upper gastrointestinal tract. Besides pancreaticoduodenectomy, which remains indicated in duodenal and ampullary cancer, less aggressive surgical procedure (such as ampullectomy) must be evaluated in selected patients with familial adenomatous polyposis patients presenting low-risk benign duodenal adenomas.


METHODS
From 1995 to 2000, we performed a retrospective, observational study, which included eight patients (5 females) with familial adenomatous polyposis underwent ampullectomy (with frozen sections) for presumed benign polyposis lesions. Six patients had an ileal pouch-anal anastomosis performed 2 to 27 years before ampullectomy. The remaining two patients had ampullectomy during the same operation than ileal pouch-anal anastomosis.


RESULTS
No patient died postoperatively. Mean hospital stay was 15 +/- 6.5 (range, 10-21) days. There was one major complication (pancreatic fistula), which was treated conservatively. Final pathologic examination of the specimens revealed that three patients had a severe dysplasia. Mean follow-up of the patients was 58 +/- 37 (range, 24-119) months. During endoscopic follow-up, although all the patients underwent endoscopic resection of duodenal polyps, none presented recurrence at the ampullectomy site.


CONCLUSIONS
Ampullectomy could be safely proposed in selected familial adenomatous polyposis patients. Our low morbidity and the absence of recurrence after almost five years of follow-up suggests that such conservative treatment could be proposed before pancreaticoduodenectomy in patients with high-risk ampullary adenomas without invasive carcinoma.
Ouaïssi
Mehdi
M
Department of General Surgery, Hospital Sainte Marguerite, Marseille , France.
Panis
Yves
Y
Sielezneff
Igor
I
Alves
Arnaud
A
Pirrò
Nicolas
N
Robitail
Stéphane
S
Heyries
Laurent
L
Valleur
Patrice
P
Sastre
Bernard
B
D000236:Adenoma / Q000517:prevention & control; D011125:Adenomatous Polyposis Coli / Q000601:surgery*; D000328:Adult; D000368:Aged; D014670:Ampulla of Vater / Q000601:surgery*; D001003:Anal Canal / Q000601:surgery; D000714:Anastomosis, Surgical; D003110:Colonic Neoplasms / Q000517:prevention & control; D013505:Digestive System Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007082:Ileum / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D010190:Pancreatic Neoplasms / Q000517:prevention & control; D016577:Pancreaticoduodenectomy; D012189:Retrospective Studies; D012307:Risk Factors