Surgery for Ampulla of Vater Adenoma

Yoon, Dong Sup

Abstract

Ampullary adenoma is a very rare tumor and it is truly a premalignant neoplasm. The current methods of endoscopic biopsy and even intraoperative frozen sections are limited in their ability to rule out coexisting foci of carcinoma. So, complete removal should be obtained for the treatment of ampullary tumor. Physicians can select one of the treatment modalities, including endoscopic papillectomy, transduodenal local resection and pancreaticoduodenectomy, according to the tumor size and the co-existence of severe dysplasia, carcinoma in situ or adenocarcinoma, and the patient's medical illness. Endoscopic papillectomy can be done in the case of a small adenoma. Pancreaticoduodenectomy is now a standard treatment for a large adenoma and also adenoma with carcinoma. From the view point of organ preservation and long-term quality of life, determining the adequate indications for performing transduodenal local resection for large ampullary adenoma and adenoma with carcinoma should be done.