Proposed indications for limited resection of early ampulla of Vater carcinoma: clinico-histopathological criteria to confirm cure.
BACKGROUND
Limited resection is reserved for patients with high operative risk or benign adenomas. We aimed to define indications for limited resection of early ampulla of Vater carcinoma with curative intent through detailed preoperative examinations and histopathological evaluations.


METHODS
We performed a retrospective cohort study of all consecutive Japanese patients who underwent resection for ampulla of Vater neoplasms at our hospital from 1986 to 2010.


RESULTS
A total of 75 patients were identified. Moderately/poorly differentiated histology, lympho-vascular/perineural invasion, and duodenal/pancreatic invasion were significant risk factors for lymph node metastases. Macroscopically, non-exposed protruded- or ulcerative-type disease did not correlate directly with lymph node metastases; however, these tumor types were associated with other invasive features. In a subset of early carcinomas fulfilling the conditions of exposed protruded adenoma or papillary/well-differentiated adenocarcinoma determined by endoscopic biopsy, negative duodenal invasion determined by endoscopic ultrasonography, no tumor infiltration into the pancreatic duct determined by intraductal ultrasound, and diameter of the pancreatic duct ≤3 mm determined by endoscopic retrograde cholangiopancreatography (N = 11), the incidence of lymph node metastasis and tumor infiltration into the pancreatic duct was 0%.


CONCLUSIONS
Strictly selected patients with early ampulla of Vater carcinomas may benefit from limited resection if the resected specimen is evaluated to confirm all histopathological criteria.
Department of Surgery, Kawasaki Municipal Hospital, Shinkawadori 12, Kawasaki-ku, Kawasaki, Kanagawa, 210-0013, Japan. aiurako6@gmail.com
Koichi
K
Aiura
Taizo
T
Hibi
Hiroto
H
Fujisaki
Minoru
M
Kitago
Minoru
M
Tanabe
Shigeyuki
S
Kawachi
Osamu
O
Itano
Masahiro
M
Shinoda
Hiroshi
H
Yagi
Yohei
Y
Masugi
Michiie
M
Sakamoto
Yuko
Y
Kitagawa
D000230:Adenocarcinoma / Q000175:diagnosis* / Q000601:surgery; D000328:Adult; D000368:Aged; D014670:Ampulla of Vater / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D001706:Biopsy; D002760:Cholangiopancreatography, Endoscopic Retrograde; D003138:Common Bile Duct Neoplasms / Q000175:diagnosis* / Q000601:surgery; D013505:Digestive System Surgical Procedures / Q000379:methods*; D055088:Early Detection of Cancer / Q000379:methods*; D019160:Endosonography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods*; D012189:Retrospective Studies