Faculty Collaboration Database

A single-institution review of 157 patients presenting with benign and malignant tumors of the ampulla of Vater: management and outcomes. Surgery 2011 Aug;150(2):169-76

Date

08/02/2011

Pubmed ID

21801957

Pubmed Central ID

PMC3155697

DOI

10.1016/j.surg.2011.05.012

Scopus ID

2-s2.0-79960925881 (requires institutional sign-in at Scopus site)   45 Citations

Abstract

BACKGROUND: Although benign ampullary tumors are removed endoscopically, due to their potential to progress to malignant disease, the favored treatment for adenocarcinoma is pancreaticoduodenectomy. We reviewed our institution's experience in order to identify which patients were at highest risk of disease progression following surgical resection, as well as evaluate whether localized T1 tumors are best treated by pancreaticoduodenectomy.

METHODS: We retrospectively reviewed 157 patients who presented with an ampullary mass, from 2001 to 2010, and identified 51 with benign adenoma and 106 with adenocarcinoma.

RESULTS: Patients with malignant tumors most often presented with larger tumors and jaundice, which alone was predictive of survival (OR = 67). Forty-five percent of patients with pathologically confirmed T1 tumors had positive lymph nodes and median survival was modest at 60 months. Lymph node involvement was predictive of recurrence and decreased survival.

CONCLUSION: Patients with malignant tumors often present with jaundice and larger tumors. These findings should warrant suspicion for cancer and expedited preoperative workup. Based on our finding that nearly half the patients with T1 tumors had positive lymph nodes, we recommend pancreaticoduodenectomy for any patient with biopsy proven adenocarcinoma who is a suitable candidate for surgery.

Author List

Hornick JR, Johnston FM, Simon PO, Younkin M, Chamberlin M, Mitchem JB, Azar RR, Linehan DC, Strasberg SM, Edmundowicz SA, Hawkins WG

MESH terms used to index this publication - Major topics in bold

Adenocarcinoma
Adenoma
Adult
Aged
Aged, 80 and over
Ampulla of Vater
Common Bile Duct Neoplasms
Female
Humans
Male
Middle Aged
Pancreaticoduodenectomy
Retrospective Studies
Treatment Outcome
Young Adult