Ann Hepatobiliary Pancreat Surg.  2017 Aug;21(3):146-150. 10.14701/ahbps.2017.21.3.146.

Safety of duodenal ampullectomy for benign periampullary tumors

• Kim AL
• Choi YI

• KMID: 2389991
• DOI: http://doi.org/10.14701/ahbps.2017.21.3.146

Abstract

BACKGROUNDS/AIMS
Surgical resection, such as pancreaticoduodenectomy (PD), is used for treatment of benign periampullary tumors, but high morbidity and mortality resulting from PD can be a huddle. The aim of this study is to suggest a safe and less invasive procedure for treatment of benign periampullary tumors.
METHODS
From January 2001 to September 2016, 31 patients with ampulla of Vater (AOV) tumors were reviewed retrospectively. Patients who were confirmed with malignancy through biopsy were excluded, except for one patient with malignancy and multiple underlying diseases. To investigate the safety and availability of transduodenal ampullectomy (TDA), TDA and endoscopic papillectomy (EP) were compared.
RESULTS
There was no significant difference in the occurrence of complications between the TDA group and EP group (p=0.145), and the resection margins were negative in both groups. There was no recurrence in patients who had TDA, while one patient had a recurrence after EP.
CONCLUSIONS
This study suggests that TDA is as safe as EP for treating benign periampullary tumors.

Keyword

Periampullary tumor; Transduodenal ampullectomy; Endoscopic papillectomy

MeSH Terms

Ampulla of Vater
Biopsy
Humans
Mortality
Pancreaticoduodenectomy
Recurrence
Retrospective Studies

Reference

1. Branum GD, Pappas TN, Meyers WC. The management of tumors of the ampulla of Vater by local resection. Ann Surg. 1996; 224:621–627. PMID: 8916877.

2. Treitschke F, Beger HG. Local resection of benign periampullary tumors. Ann Oncol. 1999; 10(Suppl 4):212–214. PMID: 10436825.

3. Allgaier HP, Schwacha H, Kleinschmidt M, Thimme R, Schöffel U, Blum HE. Ampullary hamartoma: A rare cause of biliary obstruction. Digestion. 1999; 60:497–500. PMID: 10473976.

4. Stolte M, Pscherer C. Adenoma-carcinoma sequence in the papilla of Vater. Scand J Gastroenterol. 1996; 31:376–382. PMID: 8726307.

5. de Castro SM, van Heek NT, Kuhlmann KF, Busch OR, Offerhaus GJ, van Gulik TM, et al. Surgical management of neoplasms of the ampulla of Vater: local resection or pancreatoduodenectomy and prognostic factors for survival. Surgery. 2004; 136:994–1002. PMID: 15523392.

6. Halsted WS. Contributions to the surgery of the bile passages, especially of the common bile duct. Boston Med Surg J. 1899; 141:645–654.

7. Whipple AO, Parsons WB, Mullins CR. Treatment of carcinoma of the ampulla of vater. Ann Surg. 1935; 102:763–779. PMID: 17856666.

8. Shemesh E, Nass S, Czerniak A. Endoscopic sphincterotomy and endoscopic fulguration in the management of adenoma of the papilla of Vater. Surg Gynecol Obstet. 1989; 169:445–448. PMID: 2683151.

9. Lambert R, Ponchon T, Chavaillon A, Berger F. Laser treatment of tumors of the papilla of Vater. Endoscopy. 1988; 20(Suppl 1):227–231. PMID: 3168951.

10. Standards of Practice Committee. Adler DG, Qureshi W, Davila R, Gan SI, Lichtenstein D, et al. The role of endoscopy in ampullary and duodenal adenomas. Gastrointest Endosc. 2006; 64:849–854. PMID: 17140885.

11. Binmoeller KF, Boaventura S, Ramsperger K, Soehendra N. Endoscopic snare excision of benign adenomas of the papilla of Vater. Gastrointest Endosc. 1993; 39:127–131. PMID: 8495831.

12. Desilets DJ, Dy RM, Ku PM, Hanson BL, Elton E, Mattia A, et al. Endoscopic management of tumors of the major duodenal papilla: Refined techniques to improve outcome and avoid complications. Gastrointest Endosc. 2001; 54:202–208. PMID: 11474391.

13. Winter JM, Cameron JL, Olino K, Herman JM, de Jong MC, Hruban RH, et al. Clinicopathologic analysis of ampullary neoplasms in 450 patients: implications for surgical strategy and long-term prognosis. J Gastrointest Surg. 2010; 14:379–387. PMID: 19911239.

14. Lee SY, Jang KT, Lee KT, Lee JK, Choi SH, Heo JS, et al. Can endoscopic resection be applied for early stage ampulla of Vater cancer? Gastrointest Endosc. 2006; 63:783–788. PMID: 16650538.

15. Seewald S, Omar S, Soehendra N. Endoscopic resection of tumors of the ampulla of Vater: how far up and how deep down can we go? Gastrointest Endosc. 2006; 63:789–791. PMID: 16650539.

16. Han J, Kim MH. Endoscopic papillectomy for adenomas of the major duodenal papilla (with video). Gastrointest Endosc. 2006; 63:292–301. PMID: 16427938.

17. Bellizzi AM, Kahaleh M, Stelow EB. The assessment of specimens procured by endoscopic ampullectomy. Am J Clin Pathol. 2009; 132:506–513. PMID: 19762527.

18. Chijiiwa K, Yamashita H, Kuroki S. Wide ampullectomy for patients with villous adenoma of duodenal papilla and follow-up results of pancreaticobiliary tract. Int Surg. 1994; 79:178–182. PMID: 7928158.

19. Hornick JR, Johnston FM, Simon PO, Younkin M, Chamberlin M, Mitchem JB, et al. A single-institution review of 157 patients presenting with benign and malignant tumors of the ampulla of Vater: management and outcomes. Surgery. 2011; 150:169–176. PMID: 21801957.

20. Gassler N, Knüchel R. Tumors of Vater's ampulla. Pathologe. 2012; 33:17–23. PMID: 22293786.

21. Sharma P, Montgomery E. Gastrointestinal dysplasia. Pathology. 2013; 45:273–285. PMID: 23442738.

22. Grobmyer SR, Stasik CN, Draganov P, Hemming AW, Dixon LR, Vogel SB, et al. Contemporary results with ampullectomy for 29 "benign" neoplasms of the ampulla. J Am Coll Surg. 2008; 206:466–471. PMID: 18308217.