Local resection of benign periampullary tumors

Abstract

Benign tumours of the ampulla of Vater are rare and histologically mostly villous or tubulovillous adenomas. The frequency of malignant lesion in an adenoma of the papilla figures around 26%. Villous adenoma of the ampulla is considered as premalignant lesion. Various techniques have been advocated ranging from simple excision of the ampullary tumour and the contiguous duodenal mucosa to wide resection of the mass including the papilla and adjacent duodenal, ductal, and pancreatic tissue. In this study, 41 patients suffering from a benign tumor of the Ampulla of Vater were examined. Sixty-six percent of all patients exhibited a villous or tubulovillousadenoma with medium or severe degree of dysplasia. Thirty-six patients were treated with local resection of the ampulla, using ampullectomy in 33 patients. In 5 of the 41 patients pylorus-preserving duodenopancreatectomy was applied. The median follow-up of 42 month showed no evidence of recurrent disease. Ampullectomy is an adequate way of treating benign ampullary lesions, but, precise technique is important. The decision-making should be based on histological examination of preoperative biopsy specimens and of operative frozen sections, by an experienced pathologist. If the histology of the ampullary lesion is uncertain, pylorus-preserving partial pancreaticoduodenectomy is justified in patients with low perioperative risks, and if this extended procedure can be done safely by an experienced surgeon.