Indications for and the technique of local resection of tumors of the papilla of Vater
M. Farouk, M. Niotis, G. D. Branum, P. B. Cotton and W. C. Meyers
Department of Surgery, Duke University Medical Center, Durham, NC 27710.
Local resection of tumors of the papilla of Vater was performed in six
cases (three benign adenomas and three adenocarcinomas). Pathology was
suggested in all cases by endoscopic biopsy and confirmed by operative
excision. A method of excision of the tumor and reconstruction of the
pancreaticobiliary apparatus was used that eliminated all gross and
microscopic disease. Only one of the patients with benign disease (familial
polyposis) suffered from local recurrence. All three patients with
malignant tumors developed local recurrences within 2 years of resection.
Local resection seems to be a viable alternative to Whipple's resection in
patients with benign tumors. In malignant cases, local resection should be
considered only a palliative procedure and confined to elderly patients
with severe concomitant disease and patients in whom a more radical
procedure would incur an undue surgical risk.
