Ann Surg Treat Res.  2018 Jul;95(1):22-28. 10.4174/astr.2018.95.1.22.

Transduodenal ampullectomy for ampullary tumors - single center experience of consecutive 26 patients

• Hong S
• Song KB
• Lee YJ
• Park KM
• Kim SC
• Hwang DW
• Lee JH
• Shin SH
• Kwon J
• Ma CH
• Hwang S
• Park G
• Park Y
• Lee SJ
• Kim YW

• KMID: 2414449
• DOI: http://doi.org/10.4174/astr.2018.95.1.22

Abstract

PURPOSE
Transduodenal ampullectomy (TDA) has been reported in a limited number of cases and in a small number of case series. The aim of this study was to analyze perioperative and long-term oncological outcomes of patients with ampullary tumors who underwent TDA in a single large-volume center.
METHODS
Through a retrospective review of data from 2004 to 2016, we identified 26 patients who underwent TDA at Asan Medical Center.
RESULTS
Eleven of 26 patients underwent TDA for T1 and carcinoma in situ (high-grade dysplasia) cancer; these patients are still alive without recurrence. A major in-hospital complication (3.8%) occurred in 1 case, but there was no case of 90-day mortality. In addition, none of the patients was diagnosed as having newly developed diabetes mellitus after TDA. No significant differences were found between open and laparoscopic-TDA in terms of operation time, painkiller use, and hospital stay.
CONCLUSION
TDA is a feasible and effective surgical procedure for the treatment of selected patients with ampullary tumors. It is an alternative treatment option in cases of ampullary tumors not amenable to endoscopic papillectomy or pancreaticoduodenectomy.

Keyword

Ampulla of Vater; Transduodenal ampullectomy; Ampullary tumor

MeSH Terms

Ampulla of Vater
Carcinoma in Situ
Chungcheongnam-do
Diabetes Mellitus
Humans
Length of Stay
Mortality
Pancreaticoduodenectomy
Recurrence
Retrospective Studies

Figure

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  Fig. 1 Choledochoduodenostomy (a), pancreaticoduodenostomy (b), and common channel (c). After the lesion is excised with both ducts, single layer duct to mucosa choledochoduodenostomy, pancreaticoduodenostomy, and common channel between bile and pancreatic duct are done with 5/0 PDS (Ethicon US, LLC, Cincinnati, OH, USA).

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  Fig. 2 Placement of trocars for laparoscopic transduodenal ampullectomy. (a) 12 mm trocar on the umbilicus for the right hand of the operator. (b) 5mm trocar on the right flank for the left hand of the operator. (c) 5mm trocar on the left flank for surgical assistance. (d) 12mm trocar for the laparoscope.

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