Local resection for ampullary tumors. Is there a place for it?
H. J. Asbun, R. L. Rossi and J. L. Munson
Department of General Surgery, Lahey Clinic Medical Center, Burlington, MA 01805.
Two of 14 patients with adenomas were without disease 25 and 43 months
after ampullary resection. Two patients with an initial diagnosis of
malignant neoplasm had no recurrence at 75 and 40 months; one underwent
pancreatoduodenectomy at 8 months because of recurrence. Six of nine
patients with initial diagnoses of villous adenoma were without disease at
1, 2, 16, 23, 46, and 51 months; three underwent conversion to
pancreatoduodenectomy because of invasive carcinoma. Frozen-section studies
revealed adenocarcinoma in two patients with villous adenoma but failed to
show invasion in one patient. One patient with villous adenoma was
mistakenly thought to have carcinoma based on results of frozen-section
studies. Local ampullary resection is valuable in treating benign and
selected premalignant and malignant ampullary lesions. The threshold for
conversion to pancreatoduodenectomy should be low unless ampullectomy is
performed with palliative intent.
