Clinicopathologic Analysis of Ampullary Neoplasms in 450 Patients: Implications for Surgical Strategy and Long-Term Prognosis

Abstract

When surgery is indicated, radical resection is required for early invasive adenocarcinoma of the ampulla of Vater, as lymph node metastases are present in nearly 30% of patients with T1 disease. Pancreaticoduodenectomy should be the preferred approach for most ampullary neoplasms that require surgical resection.

Diagnostic Ability of Diffusion-weighted Magnetic Resonance Imaging to Discriminate Ampullary Neoplasms: A Preliminary Study of 15 Cases

“…We recognize that our current management algorithm for ampullary lesions, which includes EP, should be considered challenging at this stage because the occurrence rate of potentially life-threatening complications in patients receiving EP is reported to be markedly higher than in those who underwent endoscopic resection of gastric or colonic lesion, and the efficacy of EP remains unjustifiable [1][2][3][4] . Furthermore, it is uncertain which of the following should be applied for a salvage procedure when the ampullectomy margin is positive for tumor, i.e., repeat endoscopic resection, transduodenal resection, or PD [1][2][3][4] .…”

“…Furthermore, it is uncertain which of the following should be applied for a salvage procedure when the ampullectomy margin is positive for tumor, i.e., repeat endoscopic resection, transduodenal resection, or PD [1][2][3][4] . Thus it is difficult to state that EP is an established treatment procedure.…”

“…EP is obviously a more complicated procedure and thus considered to adversely affect the adjacent tissues more than biliary stenting alone, suggesting that PD following ampullectomy could be more technically difficult than PD without prior ampullectomy. Conversely, it is obviously excessive if PD is applied for localized adenoma with low-grade dysplasia [1][2][3][4] . In other words, an inappropriate choice of treatment procedure would have a markedly larger impact on the clinical course in patients with ampullary lesions than in patients with early gastric or colonic cancer, both of which are often treated endoscopically [1][2][3][4][16][17][18] ; thus, accurate preprocedural diagnosis is essential for avoiding such an inappropriate choice.…”

“…Ampullary neoplasms occur rarely and have a complex anatomy, making it difficult to accomplish accurate preprocedural diagnosis [1][2][3][4] . The primary cause of this difficulty is the diagnostic uncertainty of endoscopic biopsy for ampullary lesions ; i.e., false-negative findings for cancer are frequent in the ampulla of Vater [1][2][3][4] .…”

“…The primary cause of this difficulty is the diagnostic uncertainty of endoscopic biopsy for ampullary lesions ; i.e., false-negative findings for cancer are frequent in the ampulla of Vater [1][2][3][4] . Consequently, inappropriate treatment procedures are sometimes performed including pancreaticoduodenectomy PD for localized adenoma and ampullectomy for hyperplasia or invasive adenocarcinoma [1][2][3][4] . Therefore, a more reliable method of endoscopic biopsy and / or better supplemental diagnostic tools are needed to achieve more accurate preprocedural diagnoses of ampullary lesions.…”