Hasan ÖZKAN, Mustafa YAKUT, Gökhan KABAÇAM, Abdulkadir DÖKMECİ, Necati ÖRMECİ

Long-term results of pancreaticoduodenectomy and endoscopic resection in the treatment of early stage carcinoma of the ampulla of Vater: case series and review of the literature

We retrospectively evaluated 6 cases to explore the role of curative pancreaticoduodenectomy and endoscopic resection of ampulla of Vater tumors. Six patients diagnosed with stage 1 ampullary tumors at Ankara University Hospital between January 1994 and September 2009 were analyzed retrospectively. Icterus was the cardinal symptom in all patients. The median time for the symptoms caused by the lesion of the papilla was 7 weeks in patients with carcinoma. The diameters of the visualized tumors were less than 20 mm. Diabetes mellitus was observed in 2 patients. When the patients were classified according to TNM staging, all patients were in stage 1. Endoscopic resection was performed in 3 patients, and the other 3 patients underwent curative pancreaticoduodenectomy. The mean ages in the curative pancreaticoduodenectomy group and endoscopic resection group were 54.3 and 80.3 years, respectively. Tumor recurrence was not observed in any patient. Among the endoscopic resection group, there was no sign of tumor recurrence for 72 months in 1 patient, 6 months in another patient, and 46 months in the last patient. One of the patients died 46 weeks after endoscopic ampullectomy. This patient also had diabetes mellitus and cardiac problems. Radical pancreaticoduodenectomy is presently the most common method for resecting malignant ampullary tumors. Endoscopic resection of carcinoma of the ampulla of Vater appears to be an alternative to surgical therapy, particularly in patients for whom surgical approach carries a high risk.

Anahtar Kelimeler:

Key words: Carcinoma, ampulla of Vater, endoscopic resection, pancreaticoduodenectomy

Long-term results of pancreaticoduodenectomy and endoscopic resection in the treatment of early stage carcinoma of the ampulla of Vater: case series and review of the literature

Keywords:

Key words: Carcinoma, ampulla of Vater, endoscopic resection, pancreaticoduodenectomy,

PDF

___

Lorenzo-Zuniga V, Moreno De Vega V, Domenech E, Boix J. Diagnosis and treatment of ampullary tumors. Gastroenterol Hepatol 2009; 32: 101-8 (article in Spanish).
Huang YT, Xing MR. Local resection for the treatment of carcinoma of the papilla of Vater. Zhonghua Wai Ke Za Zhi 1994; 32: 603-5. 3. Charton JP, Deinert K, Schumacher B, Neuhaus H. Endoscopic resection for neoplastic diseases of the papilla of Vater. J Hepatobiliary Pancreat Surg 2004; 11: 245-51.
Rusell DM, Roberts-Th omson IC, Macrea FA, Kune GA, Sherson ND. Carcinoma of the papilla of Vater. Aust N Z J Surg 1982; 52: 44-7.
Erdmann K, Barten M. Clinical aspects, diagnosis, and therapy of cancer of Vater’s ampulla. Z Gesamte Inn Med 1989 15; 44: 617-21.
Alibegov RA, Prokhorenko TI, Sergeev OA, Khlusov AN. Th e long term results and survival prognostic factors of surgical treatment ampulla Vateri cancer. Khirurgiia (Mosk) 2008; 4: 27-30 (article in Russian).
Allema JH, Reinders ME, Van Gulik TM, Van Leeuwen DJ, Verbeek PC, De Wit LT et al. Results of pancreaticoduodenectomy for ampullary carcinoma and analysis of prognostic factors for survival. Surgery 1995; 117: 247-53.
Hartenfels IM, Dukat A, Burg J, Hansen M, Jung M. Adenomas of Vater’s ampulla and of the duodenum. Presentation of diagnosis and therapy by endoscopic interventional and surgical methods. Chirurg 2002; 73: 235-40 (article in German).
Morales-Linares JC, Gomez Mensez TJ, Chan C, Quintanilla-Martinez L, Uscange L, Robles-Diaz G et al. Pancreatoduodenectomy in the treatment of carcinoma of Vater’s ampulla. Rev Invest Clin 1996; 48: 185-9.
Sharp KW, Brandes J. Local resection of tumors of the ampulla of Vater. Am Surg 1990; 56: 214-7.
Schoeman MN, Huibregtse K. Pancreatic and ampullary carcinoma. Gastrointestinal Endosc Clin N Am 1995; 5: 217- 36.
Alstrup N, Burcharth F, Hauge C, Horn T. Transduodenal excision of tumours of the ampulla of Vater. Eur J Surg 1996; 162: 961-7.
Bruttocao A, De Santis L, Militello C, Martella B, Terranova O. Th erapeutic strategy in neoplasia of the pancreas and ampulla. Ann Ital Chir 2003; 74: 269-74.
Motton G, Veraldi GF, Fracastoro G, Ricci F, Laterza E, Dorucci V et al. Vater’s papilla and periampullary area villous adenoma: personal experience about nine cases and review of the literature. Hepatogastroenterology 1996; 43: 448-55.
Lee JH, Whittington R, Williams NN, Berry MF, Vaughn DJ, Haller DG et al. Outcome of pancreaticoduodenectomy and impact of adjuvant therapy for ampullary carcinomas. Int J Radiat Oncol Biol Phys 2000; 47: 945-53.
Huibregtse K, Tygat GN. Carcinoma of the ampulla of Vater: the endoscopic approach. Endoscopy 1988; 20 Suppl 1: 223-6.
Farouk M, Niotis M, Branum GD, Cotton PB, Meyers WC. Indications for and the technique of local resection of tumors of the papilla of Vater. Arch Surg 1991; 126: 650-2.
Kobayashi A, Konishi M, Nakagohri T, Takahashi S, Kinoshita T. Th erapeutic approach to tumors of the ampulla of Vater. Am J Surg 2006; 192: 161-4.
Martin JA, Haber GB. Ampullary adenoma: clinical manifestations, diagnosis, and treatment. Gastrointestinal Endosc Clin N Am 2003; 13: 649-69.