Transduodenal excision of tumours of the ampulla of Vater.

OBJECTIVE

To evaluate the symptoms, diagnostic procedures, and treatment by transduodenal excision, of tumours in the ampulla of Vater.

DESIGN

Open study of consecutive patients.

SETTING

University hospital, Denmark.

SUBJECTS: Six patients with tumours in the ampulla of Vater.

INTERVENTIONS: Ultrasonography, duodenoscopy, and endoscopic retrograde cholangiopancreatography (ERCP). Endoscopic biopsy if tumour was visible at the papilla. Transduodenal excision of the ampulla and anastomoses of the common duct and pancreatic duct to the duodenum.

MAIN OUTCOME MEASURES: Postoperative complications and survival.

RESULTS

None of the tumours could be seen on ultrasonography. All the tumours were diagnosed on duodenoscopy with ERCP. The histopathological diagnoses of the endoscopic biopsy specimens were adenoma (n = 3), suspicion of adenocarcinoma (n = 2), and adenocarcinoma (n = 1). Curative resection by transduodenal excision of the ampulla of Vater was possible in all cases. Pathological examination of the surgical specimens showed three adenomas and three adenocarcinomas. One patient had a recurrence after 2.5 years and had a further resection. Three patients died after one, three, and nine years, respectively; two had no recurrence and one was suspected of having one. The other three patients were alive 8-20 months after the operation.

CONCLUSION

The procedure is recommended for small and probably benign tumours and, when technically possible, in malignant tumours in patients at high operative risk. Close postoperative follow-up with duodenoscopy and ERCP is recommended.