In:
HPB Surgery, Hindawi Limited, Vol. 11, No. 5 ( 2000-01-01), p. 325-331
Abstract:
Introduction: Duodenal villous adenoma arising
from the ampulla of Vater has a high risk of malignant development. Excluding associated malignant
disease prior to resection of an adenoma of the ampulla is not always possible. Therefore, the surgical
procedure of choice to treat this rare tumour is still controversial. Objective: To evaluate retrospectively results of treatment
of villous adenoma arising from ampulla of Vater with dysplasia or associated carcinoma limited
to the ampulla. Patients and Methods: From 1985 to 1996, eight
patients have been diagnosed with ampullary villous adenoma suitable for resection. We have reviewed
treatment, morbidity, mortality, follow-up and final outcome. Results: Pancreatoduodenectomy (PD) was performed
in 4 patients. Transduodenal ampullectomy and endoscopic resection was performed in 2 patients
each. There was no perioperative mortality. None of the patients had biliary, pancreatic or intestinal
leakage but two patients who underwent PD had minor postoperative complications. The mean
follow-up was 44 (range: 6–132) months. Villous adenoma was associated with adenocarcinoma in
50% of the cases (4/8 patients). During the fol lowup
both patients who underwent transduodenal ampullectomy developed recurrent disease. All patients
initially treated by PD are alive without evidence of recurrent disease. Conclusions: Treatment of villous adenoma of the
ampulla must be individualized within certain limits. In our series, PD achieve good results and it appears
to be the procedure of choice in order to treat villous adenomas with proved presence of carcinoma,
carcinoma in situ or severe dysplasia. Endoscopic
or local resection may be appropriate for small benign tumours in high risk patients.
Type of Medium:
Online Resource
ISSN:
0894-8569
Language:
English
Publisher:
Hindawi Limited
Publication Date:
2000
detail.hit.zdb_id:
2031561-2
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