Abstract
Background. Ampullary tumors should be resected because of the high incidence of malignancy and
the unreliability of preoperative endoscopic diagnosis. Controversy exists about whether
to perform a transduodenal excision (TDE) or a pancreatoduodenectomy. This study evaluated
the safety and long-term efficacy of TDE. Methods. The records of 21 patients with a pathologic diagnosis of ampullary adenoma who underwent
TDE were reviewed. Demographics, symptoms, pathologic findings, and outcomes were
analyzed and long-term follow-up was ascertained. Results. Twenty-one patients (mean age, 61 years) underwent TDE. Final pathology showed adenoma
in all patients including 1 (5%) with invasive cancer, 2 (9%) with microinvasive cancer,
6 (28%) with high-grade dysplasia, and 1 (5%) with low-grade dysplasia. The overall
survival was 85% (mean follow-up of 38 months). One of 3 late deaths was likely related
to disease progression. Sixteen of the 18 remaining patients (89%) had no evidence
of tumor recurrence. One benign ampullary recurrence was successfully treated endoscopically.
One additional patient developed an ampullary cancer and underwent pancreatoduodenectomy.
Conclusions. TDE of benign ampullary tumors, even those with varying grades of dysplasia, can
be performed with acceptable morbidity and low rates of recurrence. Postoperative
endoscopic surveillance is mandatory to identify recurrent tumors. (Surgery 2000;128:694-701.)
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Article info
Footnotes
*Reprint requests: Frederic Eckhauser, MD, Professor and Chief, Division of Gastrointestinal Surgery, University of Michigan Medical Center, TC2922G, Box 0331, 1500 E Medical Center Drive, Ann Arbor, MI 48109.
**Surgery 2000;128:694-701
Identification
Copyright
© 2000 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
