Local excision as a treatment for tumors of ampulla of Vater.
BACKGROUND
Although local excision (ampullectomy) was first described by Halsted in 1899, its adequacy as an alternative surgical treatment for the ampullary tumors is still a matter of debate. The aim of this study was to evaluate the results of ampullectomy as a curative treatment for benign and malignant tumors arising from the ampulla, in a 14-year single-institution experience.


METHODS
From 1990 to 2004, a total of 20 patients of adenocarcinoma (12) or adenoma (8) of the ampulla of Vater underwent local excision. Clinical data were collected and morbidity, mortality, as well as long-term survival were evaluated. The usefulness of several pre or intraoperative diagnostic methods was also recorded. Median follow-up was 85 (range 6-180) months.


RESULTS
The combination of endoscopic preoperative biopsies and intraoperative frozen section examination adequately diagnosed ampullary tumors in all cases. The postoperative morbidity and mortality were 0%, whereas the 3 and 5-year survival rates for the patients with adenocarcinoma was 75 % and 33.3 % respectively. All the patients with adenoma are still alive without any sign of recurrence.


CONCLUSIONS
In our series, local excision was a safe option, associated with satisfactory long-term survival rates in patients with benign lesions and in those with small(<2 cm), pT1, well differentiated ampullary tumours without nodal involvement.
Demetriades
Haralampos
H
4th Surgical Department, Aristotle University of Thessaloniki, G. Papanikolaou' General Hospital, Exohi, Thessaloniki 57010, Greece. haral@med.auth.gr
Zacharakis
Emmanouil
E
Kirou
Ioanna
I
Pramateftakis
Manousos-Georgios
MG
Sapidis
Nikolaos
N
Kanellos
Ioannis
I
Betsis
Dimitrios
D