Benign tumour of the ampulla of vater: surgical treatment and prognosis

Abstract

Wide excision of the ampulla with reconstruction and reimplantation of the duct is adequate treatment for benign lesions. If the histological picture is uncertain, partial pancreaticoduodenectomy is justified in patients at low risk.

Résultat à long terme de 26 ampullectomies chirurgicales

“…Dans notre travail, la mortalité nulle est conforme aux données récentes de la littérature [1,[8][9][10][11], mais contraste avec celle de 9 % rapportée dans le rapport de l'AFC de Marchal en 1978 [8]. Les progrès conjoints des techniques chirurgicales et de la prise en charge périopératoire permettent de proposer cette intervention à la condition d'une sélection préalable des malades.…”

“…Les progrès conjoints des techniques chirurgicales et de la prise en charge périopératoire permettent de proposer cette intervention à la condition d'une sélection préalable des malades. Il s'agit pourtant d'une intervention de moins en moins réalisée si l'on en croit les données de la littérature : 19 % des exérèses pancréatiques en 1978 contre 0 % pour des travaux plus récents [1,2,6,9,10]. La morbidité postopéra-toire n'est pas en cause pour expliquer ce phénomène.…”

Rationale for endoscopic management of adenoma of the papilla of Vater: options and limitations

“…In controlled, prospective studies, methods such as hypotonic duodenography [53], CT [9], magnetic resonance imaging (MRI), magnetic resonance cholangiopancreatography (MRCP) [2], and US [21,29] were significantly inferior to endoscopic diagnosis. Macroscopic appearance, site and size of the lesion, and tumoral stenosis can be visualized selectively using endoscopy, e.g., side view duodenoscopy (SVD) [33,34].…”

“…Overstaging is reported to occur in as many as one third of T1 lesions [31], which is often due to inflammatory edema of the submucosa or from associated pancreatitis. EUS has been used as the most accurate way of identifying superficial tumors (adenomas and intramucosal carcinomas) suitable for local resection [59,64,31] and determining tumor stage prior to surgery [2,53,21,29,46,63,62]. Several studies have reported an overall accuracy rate of EUS of 78-90.6% [21,46,62,31,70].…”

“…Due to the low incidence of the disease, controlled therapy studies have not been conducted so far. Published results from surgical and endoscopic centers can hardly be compared because of significant differences in patient age, comorbidity, and general health status [57,43,33,53,42,13,8,25,12,67,18,4,6,14].…”