title: A single-institution review of 157 patients presenting with benign and malignant tumors of the ampulla of Vater: management and outcomes.
abstract: BACKGROUND
  Although benign ampullary tumors are removed endoscopically, due to their potential to progress to malignant disease, the favored treatment for adenocarcinoma is pancreaticoduodenectomy. We reviewed our institution's experience in order to identify which patients were at highest risk of disease progression following surgical resection, as well as evaluate whether localized T1 tumors are best treated by pancreaticoduodenectomy.
  
  
  METHODS
  We retrospectively reviewed 157 patients who presented with an ampullary mass, from 2001 to 2010, and identified 51 with benign adenoma and 106 with adenocarcinoma.
  
  
  RESULTS
  Patients with malignant tumors most often presented with larger tumors and jaundice, which alone was predictive of survival (OR = 67). Forty-five percent of patients with pathologically confirmed T1 tumors had positive lymph nodes and median survival was modest at 60 months. Lymph node involvement was predictive of recurrence and decreased survival.
  
  
  CONCLUSIONS
  Patients with malignant tumors often present with jaundice and larger tumors. These findings should warrant suspicion for cancer and expedited preoperative workup. Based on our finding that nearly half the patients with T1 tumors had positive lymph nodes, we recommend pancreaticoduodenectomy for any patient with biopsy proven adenocarcinoma who is a suitable candidate for surgery.
authors.affiliation: Division of Hepatobiliary, Pancreatic, and Gastrointestinal Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA.
authors.forename: John R
authors.initials: JR
authors.lastname: Hornick
authors.forename: Fabian M
authors.initials: FM
authors.lastname: Johnston
authors.forename: Peter O
authors.initials: PO
authors.lastname: Simon
authors.forename: Morgan
authors.initials: M
authors.lastname: Younkin
authors.forename: Michael
authors.initials: M
authors.lastname: Chamberlin
authors.forename: Jonathan B
authors.initials: JB
authors.lastname: Mitchem
authors.forename: Riad R
authors.initials: RR
authors.lastname: Azar
authors.forename: David C
authors.initials: DC
authors.lastname: Linehan
authors.forename: Steven M
authors.initials: SM
authors.lastname: Strasberg
authors.forename: Steven A
authors.initials: SA
authors.lastname: Edmundowicz
authors.forename: William G
authors.initials: WG
authors.lastname: Hawkins
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery*; D000236:Adenoma / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014670:Ampulla of Vater; D003138:Common Bile Duct Neoplasms / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016577:Pancreaticoduodenectomy; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult