title: Surgical technique for complete resection of the extrahepatic portion of the common bile duct and the ampulla of Vater for tumors of the ampulla of Vater.
abstract: BACKGROUND
  Ampullary tumors have to be completely resected, but substantial morbidity and mortality rates are associated with pancreaticoduodenectomy (PD). Local resection can be the procedure of choice in selected ampullary lesions for high-risk patients.
  
  
  METHODS
  Preoperative examination indicated that the ampullary tumor extended into the common bile duct without evidence of pancreatic duct involvement and no definite invasion into either the duodenum or the pancreas. We performed a complete resection of the extrahepatic bile duct and the ampulla of Vater, including the tumor, without performing PD by dissecting the intrapancreatic bile duct from the pancreas both downward towards the ampulla of Vater and upward using a transduodenal approach.
  
  
  RESULTS
  The operation was successfully completed, and the postoperative course was uneventful, with the exception of a minor pancreatic fistula from retropancreatic dissection. The final pathological examination demonstrated well-differentiated tubular adenocarcinoma limited to the mucosa with negative surgical margins.
  
  
  CONCLUSIONS
  Complete resection of the extrahepatic bile duct and the ampulla of Vater through a transduodenal approach can be a feasible and safe surgical procedure for selected ampullary tumors in high-risk patients.
authors.affiliation: Department of Surgery, Keio University School of Medicine, Shinanomachi 35, Shinjuku-ku, Tokyo 160-8582, Japan. aiurako@sc.itc.keio.ac.jp
authors.forename: Koichi
authors.initials: K
authors.lastname: Aiura
authors.forename: Masahiro
authors.initials: M
authors.lastname: Shinoda
authors.forename: Ryo
authors.initials: R
authors.lastname: Nishiyama
mesh_terms: D014670:Ampulla of Vater / Q000601:surgery*; D017734:Bile Ducts, Extrahepatic / Q000601:surgery*; D001706:Biopsy; D002760:Cholangiopancreatography, Endoscopic Retrograde; D003135:Common Bile Duct / Q000601:surgery*; D003138:Common Bile Duct Neoplasms / Q000175:diagnosis / Q000601:surgery*; D019160:Endosonography; D005260:Female; D006801:Humans; D008875:Middle Aged; D016577:Pancreaticoduodenectomy / Q000379:methods*; D014057:Tomography, X-Ray Computed