Local resection or pancreaticoduodenectomy for villous adenoma of the ampulla of Vater diagnosed before operation

Abstract

Background: Treatment of ampullary adenoma is complicated by difficult preoperative staging, malignant potential and a high recurrence rate. This study was designed to assess the accuracy of diagnosis and staging by endoscopic biopsy and endosonography, and to compare the results of local resection and pancreaticoduodenectomy (Whipple procedure).

Methods: All 23 patients, diagnosed by endoscopic biopsy and surgically treated by local resection (n = 12) or pancreaticoduodenectomy (n = 11) between 1984 and 1994, were analysed retrospectively.

Results: Pancreaticoduodenectomy was associated with more complications (seven of 11 patients versus three of 12) and a longer hospital stay (36 versus 18 days) than local resection. After local resection tumour excision was incomplete in half of the patients. One patient died after a Whipple procedure. Endoscopic biopsy did not identify infiltrating carcinoma in seven of the 23 patients. Endoscopic ultrasonography had a 44 per cent accuracy rate for tumour invasion and was false positive for lymph node metastases in five of 16 patients. After local resection one recurrence was observed during follow-up and one possibly died from tumour recurrence.

Conclusion: Diagnosis and staging of ampullary adenomas by endoscopic biopsy and endosonography was unreliable. Local resection seems a viable alternative for patients whose general condition does not allow a Whipple procedure.