A single-institution review of 157 patients presenting with benign and malignant tumors of the ampulla of Vater: Management and outcomes

Abstract

Introduction While benign ampullary tumors are removed endoscopically, due to their potential to progress to malignant disease, the favored treatment for adenocarcinoma is pancreaticoduodenectomy. We reviewed our institution’s experience in order to identify which patients were at highest risk of disease progression following surgical resection, as well as evaluate whether localized T1 tumors are best treated by pancreaticoduodenectomy. Methods We retrospectively reviewed 157 patients who presented with an ampullary mass, from 2001 to 2010, and identified 51 with benign adenoma and 106 with adenocarcinoma. Results Patients with malignant tumors most often presented with larger tumors and jaundice, which alone was predictive of survival (OR 67). Forty-five percent of patients with pathologically confirmed T1 tumors had positive lymph nodes and median survival was modest at 60 months. Lymph node involvement was predictive of recurrence and decreased survival. Conclusions Patients with malignant tumors often present with jaundice and larger tumors. These findings should warrant suspicion for cancer and expedited preoperative workup. Based on our finding that nearly half the patients with T1 tumors had positive lymph nodes, we recommend pancreaticoduodenectomy for any patient with biopsy proven adenocarinoma who is a suitable candidate for surgery.

Endoscopic papillectomy andKRASexpression in the treatment of adenoma in the major duodenal papilla

“…When the lesions are large, en bloc resection is more difficult, and a piecemeal approach must often be adopted. In our material, the chance of finding an undiagnosed adenocarcinoma increased as the size of the lesion increased, an observation also reported by Hornick et al [32]. We found that increasing size was also associated with increased expression of mutated KRAS and, therefore, might indicate greater neoplastic potential.…”

“…We, together with several others [16,30,32,33], have observed that obstructive jaundice at the time of presentation is frequently associated with an underlying, undiagnosed malignancy and a poor prognosis. Therefore, when patients present with jaundice, all efforts should be made to optimize preinterventional staging before decisions are made about definite treatment.…”

Endoskopische Papillenresektion: Indikation und Grenzen

“…Die Autoren der Studie schlugen daher vor, dass Adenome >1,5 cm einer chirurgischen Therapie zugeführt werden sollten. Dieses Vorgehen konnte von einer weiteren Studie von Hornick et al [75] unterstützt werden.…”

Substaging Nodal Status in Ampullary Carcinomas has Significant Prognostic Value: Proposed Revised Staging Based on an Analysis of 313 Well-Characterized Cases

“…15,23–51 Among these, lymph node (LN) status has been identified as an important predictor of survival in multiple studies. 15,26–43 In those studies that found no association between LN involvement and prognosis, 25 the negative result is likely attributable to the variable definition of ampullary cancer.…”