J Korean Surg Soc.  2011 Oct;81(4):250-256. 10.4174/jkss.2011.81.4.250.

Role of transduodenal ampullectomy for tumors of the ampulla of Vater

• Kim J
• Choi SH
• Choi DW
• Heo JS
• Jang KT

• KMID: 1445745
• DOI: http://doi.org/10.4174/jkss.2011.81.4.250

Abstract

PURPOSE
Tumors arising from the ampulla of Vater can be benign or malignant. Recently, endoscopic papillectomy has been employed in the management of benign ampulla of Vater tumors; however, surgical resection is the treatment of choice. The aim of this study was to define indications and suggest a role for transduodenal ampullectomy in the management of ampulla of Vater tumors.
METHODS
We retrospectively reviewed the medical records of 54 patients treated for ampulla of Vater tumors between January 1999 and December 2008.
RESULTS
Twenty-two endoscopic papillectomies and 21 transduodenal ampullectomies were performed. Four patients underwent transduodenal ampullectomy after endoscopic papillectomy due to a recurrent or remnant tumor. Recurrence or a remnant tumor was found in one patient after transduodenal ampullectomy compared to six patients after endoscopic papillectomy. Immediate intraoperative conversion from transduodenal ampullectomy to pancreaticoduodenectomy was performed in five patients based on intraoperative frozen biopsy analysis.
CONCLUSION
Transduodenal ampullectomy should be performed to treat ampulla of Vater tumors that are unsuitable for endoscopic papillectomy. Transduodenal ampullectomy can serve as an intermediate treatment option between endoscopic papillectomy and pancreaticoduodenectomy in the management of ampulla of Vater tumors.

Keyword

Ampulla of vater; Transduodenal ampullectomy; Ampullary neoplasm; Endoscopic papillectomy

MeSH Terms

Ampulla of Vater
Biopsy
Humans
Medical Records
Pancreaticoduodenectomy
Recurrence
Retrospective Studies

Figure

• 

  Fig. 1 Diagram of patients flow. ERCP, endoscopic retrograde cholangiopancreatography; PPPD, pancreaticoduodenectomy. a)Remnant tumor, margin (+). b)Remnant tumor. c)Remnant tumor, Lat. spreading type. d)Recurrence, P-duct stricture. e)Frozen: 3 adenocarcinoma, 1 carcinoid very close margin. f)Frozen; deep mucosal bile duct margin (+). g)Final pathology: benign.

• 

  Fig. 2 (A) Microphotograph of specimen of transduodenalampullectomy. Focal minimally invasive carcinoma (<5%) in the background of high grade dysplasia (circle) (H&E, ×10). (B) Magnification view of focal invasive mucinous carcinoma, marked with circle in Fig. 2A (H&E, ×100).

• 

  Fig. 3 Flowsheet of recommendation for management of AoV tumors. HGD, high grade dysplasia; LGD, low gradedysplasia; CT, computed tomography; EUS, endoscopic ultrasonogrphy; PD, pancreaticoduodenectomy; TDA, transduodenalampullectomy; EP, endoscopic papillectomy.

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