Tumor of the Ampulla of Vater

Beger, H. G.; Treitschke, Frank; Gansauge, Frank; Harada, Nobuhiko; Hiki, Naoki; Mattfeldt, Torsten

doi:10.1001/archsurg.134.5.526

Cited by 279 publications

(99 citation statements)

References 26 publications

(28 reference statements)

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“…A number of clinicopathologic factors which correlate with survival after resection of ampullary cancer have been identified: lymph node metastasis [2,10,14,15,16], depth of tumor invasion [10], histologic grade [14,16], resection margin [12], perineural invasion [17], lymphovascular invasion [14], and intraoperative transfusion [14,16]. Our study confirms that nodal involvement is a poor prognostic factor.…”

Section: Discussionsupporting

confidence: 79%

Gross Appearance of the Ampullary Tumor Predicts Lymph Node Metastasis and Outcome

Kayahara¹,

Ohta²

2010

Dig Surg

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Background/Aims: Patterns of lymph node involvement in carcinoma of the papilla of Vater (CPV) have not been studied in detail to date, and factors associated with lymphatic metastases and surgical outcome of this disease remain to be determined. Methods: Lymph node involvement and surgical outcome of 51 CPV patients were evaluated by extended lymphadenectomy specimens. Results: Lymph nodes with high metastatic potential were posterosuperior pancreaticoduodenal nodes (group 13a, 18%), posterior-inferior pancreaticoduodenal nodes (group 13b, 22%), and nodes around the superior mesenteric artery (group 14, 18%). Gross appearance of the primary tumor and depth of tumor invasion correlated with lymph node involvement (p < 0.05, respectively). A correlation with positivity was also found in groups 13 and 14. Disease-specific survival correlated with the gross appearance of the primary tumor and nodal involvement. However, there was no relationship between survival and the level of nodal involvement. Multivariate analysis indicated that the gross appearance of the tumor was the only significant independent predictor of a poor outcome. Conclusions: Gross appearance of the tumor is the most important prognosticator of lymph node metastases in CPV. Nodal dissection around the superior mesenteric artery may improve survival except in patients without invasion of the sphincter of Oddi. Pylorus-preserving pancreaticoduodenectomy is the treatment of choice.

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Section: Discussionsupporting

confidence: 79%

Gross Appearance of the Ampullary Tumor Predicts Lymph Node Metastasis and Outcome

Kayahara¹,

Ohta²

2010

Dig Surg

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“…Moreover, all adenocarcinomas do not require PD, as well as not all benign lesions are suitable for local resection [17] . Currently, overall outcomes in ampullectomy are the same or even better than those in PD in villous adenomas and pT1 adenocarcinomas [18] . Most recently, a large retrospective series of 102 patients, who were diagnosed with ampullary adenoma and underwent endoscopic resection, indicated success rate of 84% [19] .…”

Section: Discussionmentioning

confidence: 99%

“…Local recurrence rates are low, if the resection margins are of 1 cm in adenocarcinoma, and lower than 1 cm in villous adenoma cases [17,18] . Nearly 1 cm surgical margin was obtained in our patient due to TDA.…”

Section: Discussionmentioning

confidence: 99%

The clinical importance and role of transduodenal ampullectomy in a villous adenoma: A case report

Aktekin

Özkara

Gönen

2013

JST

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Ampullary adenoma is a precancerous lesion. Complete resection is required either endoscopically or surgically. We described a 64-year-old female patient with an ampullary adenoma, who was not suitable for endoscopic resection, so resection was performed by transduodenal ampullectomy. An ulcerated 16 mm × 13 mm hypoechoic ampullary polypoid lesion with high grade dysplasia and without infiltration into muscularis propria layer was reported on endosonographic examination. The electrocautery was used to resect the adenoma of ampulla. Bile and pancreatic ducts were approximated to duodenal wall via an absorbable suture (4-0 and 5-0 polydioxanone). No stent was used for bile and pancreatic ducts. Visualization of biliary and pancreatic drainages confirmed the patency of both ductal systems, which were 10 mm and 5 mm in diameters. Patient had no abnormalities related to biliary and pancreatic duct obstructions, and was discharged on postoperative day 8. Lesion had clear margins after transduodenal ampullectomy. In conclusion, although transduodenal ampullectomy (TDA) is technically demanding, our case is clinically important to demonstrate transduodenal ampullectomy is a safe alternative procedure to pancreaticoduodenectomy for adenoma of ampulla if the lesion is not suitable for endoscopic resection.

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“…In contrast, in most of the reported series of PD for periampullary tumors, pancreatic head cancer constitutes a major proportion of tumors (65%) with only 15% localized to the ampulla [12, 13, 14]. Ampullary tumors are localized on presentation in 78% of cases and seldom have vascular encasement or dissemination [15]. Nevertheless, patients with ampullary tumor have a soft pancreas, which is more prone to anastomotic leaking with its associated morbidity and mortality [16, 17].…”

Section: Discussionmentioning

confidence: 99%

Outcome following Pancreaticoduodenectomy in Patients Undergoing Preoperative Biliary Drainage / with Invited Commentary

Srivastava

Sikora²,

Kumar³

et al. 2001

Dig Surg

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Objective: To assess the role of preoperative biliary drainage (PBD) in the early outcome following pancreaticoduodenectomy (PD) for periampullary tumors. Design: Retrospective analysis of prospective database. Patients and Methods: 121 PDs were performed for periampullary tumors between 1989 and 1998. 54 patients were operated following a PBD (group A) while 67 patients were operated without PBD. 50 patients underwent internal biliary drainage while 4 patients underwent external biliary drainage. Of the 67 patients without PBD, serum bilirubin was >10 mg% in 41 patients (group B) while 26 patients had bilirubin level of <10 mg% (group C). Result: Patients were well matched for age, sex distribution, presence of medical risk factors, duration of surgery, operative blood loss and stage of disease. Group A patients had a higher incidence of wound infection (43 vs. 24%; p = 0.03), intra-abdominal abscess (28 vs. 15%; p = 0.06), pancreaticojejunal anastomotic leak (20 vs. 5%; p = 0.01) and overall infective complications (52 vs. 29%; p = 0.01) compared to group B patients, and a higher overall infective complication rate than group C patients (52 vs. 27%; p = 0.02). Group B patients had a higher incidence of intra-abdominal bleeding compared to group A (20 vs. 6%; p = 0.01) and group C patients (20 vs. 4%; p = 0.03). Reoperation rate was significantly higher in group B compared to group A patients (27 vs. 13%; p = 0.04). The mortality rates were not significantly different in the three groups. Conclusion: Patients with jaundice (>10 mg%) have a higher risk of bleeding complications while those with PBD have more infective complications. PBD should be judicially employed in selected patients.

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Tumor of the Ampulla of Vater

Cited by 279 publications

References 26 publications

Gross Appearance of the Ampullary Tumor Predicts Lymph Node Metastasis and Outcome

Gross Appearance of the Ampullary Tumor Predicts Lymph Node Metastasis and Outcome

The clinical importance and role of transduodenal ampullectomy in a villous adenoma: A case report

Outcome following Pancreaticoduodenectomy in Patients Undergoing Preoperative Biliary Drainage / with Invited Commentary

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