Abstract • Local resection of tumors of the papilla of Vater was performed in six cases (three benign adenomas and three adenocarcinomas). Pathology was suggested in all cases by endoscopic biopsy and confirmed by operative excision. A method of excision of the tumor and reconstruction of the pancreaticobiliary apparatus was used that eliminated all gross and microscopic disease. Only one of the patients with benign disease (familial polyposis) suffered from local recurrence. All three patients with malignant tumors developed local recurrences within 2 years of resection. Local resection seems to be a viable alternative to Whipple's resection in patients with benign tumors. In malignant cases, local resection should be considered only a palliative procedure and confined to elderly patients with severe concomitant disease and patients in whom a more radical procedure would incur an undue surgical risk. (Arch Surg. 1991;126:650-652) References 1. Ryan D, Schapiro R, Warshaw A. Villous tumors of the duodenum . Ann Surg . 1986;203:301-306.Crossref 2. Sohol S, Coopermann A. Villous tumor of the ampulla of Vater: an unusual cause of biliary colic and obstructive jaundice . Gastroenterology . 1978;75: 107-109. 3. Gertsch P, Matthews JB, Lerut J, Baer HU, Blumgart LH. The technique of papilloduodenectomy . Surg Gynecol Obstet . 1990;170:254-256. 4. Chatelin CL. Technique de l'ampullectomie . J Chir . 1969;97:465-468. 5. Eggink WF, Henegouwen VB, Brandt KH, Bronkhorst FB, Van der Heyde MN. Tumors of the ampulla of Vater treated by local resection: a report of five cases . Neth J Surg . 1988;40:110-113. 6. Halsted WS. Contributions to surgery of the bile passages, especially of the common bile duct . Boston Med Surg J . 1899;141:645-654.Crossref 7. Grace PA, Pitt HA, Tomkins RK, et al. Decreased morbidity and mortality after pancreaticoduodenectomy . Am J Surg . 1986;151:141-146.Crossref 8. Michelassi F, Erroi F, Dawson PJ, et al. Experience with 647 consecutive tumors of the duodenum, ampulla, head of pancreas and the distal common bile duct . Ann Surg . 1989;210:544-556.Crossref 9. Leung JWC, Emery R, Cotton PB, et al. Management of malignant obstructive jaundice at The Middlesex Hospital . Br J Surg . 1983;70:584-586.Crossref 10. Classen M. Endoscopic approach to papillary stenosis . Endoscopy . 1981;13:154-156.Crossref 11. Hulten O. On precancerous bile duct tumours . Arch Chir Scand . 1960;119:122-125. 12. Gouma DJ, Obertop H, Vismans J, Willebrand D, Soeters PB. Progression of benign epithelial ampullary tumor to adenocarcinoma . Surgery . 1987;101:501-504. 13. Rosenberg J, Welch JP, Pyrtek LJ, Walker M, Trowbridge P. Benign villous adenomas of the ampulla of Vater . Cancer . 1986;58:1563-1568.Crossref 14. Goldberg M, Zamir O, Hadary A. Wide local excision as an alternative treatment for periampullary carcinoma . Am J Gastroenterol . 1987;82:1169-1171. 15. Shemesh E, Nass A, Czerniak A. Endoscopic sphincterotomy and endoscopic fulguration in the management of adenoma of the papilla of Vater . Surg Gynecol Obstet . 1989;169:445-448. 16. Pochon T, Berger F, Chavaillon A, Bory R, Lambert R. Contribution of endoscopy to the diagnosis and treatment of tumors of the ampulla of Vater . Cancer . 1989;64:161-167.Crossref 17. Dancyger H, Rosh T, Lorenz R, et al. Preoperative staging of a distal common bile duct tumor by endoscopic ultrasound . Gastroenterology . 1988;95:219-222. 18. Robertson JFR, Imrie CW, Hole DJ, Carter DC, Blumgart LH. Management of periampullary carcinoma . Br J Surg . 1987;74:816-819.Crossref 19. Isakson G, Ihse I, Andren-Sandberg A, et al. Local excision for ampullary carcinoma: an alternative treatment in patients unfit for pancreaticoduodenectomy . Acta Chir Scand . 1981;189:129-139.
Archives of Surgery – American Medical Association
Published: May 1, 1991