title: Long-term survival after pancreaticoduodenectomy for endocrine tumors of the ampulla of Vater and minor papilla.
abstract: OBJECTIVE
  Endocrine tumors of the ampullary region are rare, and accurate indications for their management are lacking. We aimed to evaluate the outcome of surgical treatment in this indication.
  
  
  METHODS
  We reviewed all patients who submitted to a pancreaticoduodenectomy for ampullary endocrine tumors between 1982 and 2003 in our center.
  
  
  RESULTS
  Eight patients, 3 men and 5 women, with a mean age of 47.8 years (range, 37-57 years) were included. Two patients presented with Zollinger-Ellison syndrome, and 1 had neurofibromatosis. Operative mortality was nil. The mean size of the tumors was 17.4 mm (range, 5-40 mm). There were 7 well-differentiated and 1 poorly differentiated endocrine carcinomas. Seven patients had satellite lymph node metastases, and 1 had diffuse liver metastases. Median follow-up was 131 months (range, 17-315 months). At the end of the follow-up period, 5 patients were alive and disease-free; 1 patient was alive with stable liver metastases. Two patients died 17 months and 13 years after surgery, respectively, from metastasis and an unrelated cause.
  
  
  CONCLUSIONS
  This study demonstrates the high frequency of lymph node invasion in these uncommon tumors, even at an early clinical stage. Pancreaticoduodenectomy may result in prolonged survival of patients with well-differentiated tumors.
authors.affiliation: Department of Surgery, Hospices Civils de Lyon, Hôpital Edouard Herriot, Université Claude Bernard Lyon1, Université de Lyon, Villeurbanne, Lyon, France.
authors.forename: Roberto
authors.initials: R
authors.lastname: Pedicone
authors.forename: Mustapha
authors.initials: M
authors.lastname: Adham
authors.forename: Valérie
authors.initials: V
authors.lastname: Hervieu
authors.forename: Catherine
authors.initials: C
authors.lastname: Lombard-Bohas
authors.forename: Aymeric
authors.initials: A
authors.lastname: Guibal
authors.forename: Jean-Yves
authors.initials: JY
authors.lastname: Scoazec
authors.forename: Jean-Alain
authors.initials: JA
authors.lastname: Chayvialle
authors.forename: Christian
authors.initials: C
authors.lastname: Partensky
mesh_terms: D000328:Adult; D014670:Ampulla of Vater; D000970:Antineoplastic Agents / Q000627:therapeutic use; D021441:Carcinoma, Pancreatic Ductal / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D017024:Chemotherapy, Adjuvant; D003138:Common Bile Duct Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D016577:Pancreaticoduodenectomy; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents