ENDOSCOPIC AND SURGICAL TREATMENT OF AMPULLARY TUMORS: A SINGLE CENTER STUDY

Aims Neoplastic tumors of the ampulla of Vater are rare. Pathologically benign lesions are primarily indicated for endoscopic treatment. Cases of early adenocarcinomas affecting only the mucosa might be resolved by endoscopic resection in selected patients. Tumors infiltrating deeper layers of the wall must be removed by radical surgery.

Methods In the years 2012 – 2020, 63 patients with ampullary tumors were treated at the University Hospital Brno. All underwent appropriate staging examinations. The individual therapeutic options were discussed by a multidisciplinary committee. The main monitored parameters were: the type of surgery, 30 day morbidity and mortality, the results of definitive histopathological examination, adjuvant therapy and recurrence of the disease.

Results Surgical resection was indicated in 44 patients. Transduodenal ampullectomy (TDA) was performed in 11 patients. The main type of resection was pancreatoduodenectomy (PD) performed in 33 patients. 19 patients underwent endoscopic papillectomy. Definitive pathology described adenocarcinoma in 36 patients.

Conclusions In the cases of adenomas of ampullary tumors endoscopic treatment is indicated. In early stages of ampullary carcinoma, it is appropriate to consider an endoscopic solution in selected patients. If endoscopic treatment is not possible due to the extent or biological nature of the lesion, a radical surgical solution with a preference for PD is fully indicated. TDA can be considered in polymorbid and elderly patients without suspected lymph node involvement. In all our patients with pT1a adenocarcinomas (n=3), all nodes removed were pathologically negative. These patients could benefit from endoscopic resection or TDA.

Publication History

Article published online:
14 April 2022