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.
Subject(s)
Humans , Ampulla of Vater , Carcinoma in Situ , Diabetes Mellitus , Length of Stay , Mortality , Pancreaticoduodenectomy , Recurrence , Retrospective StudiesABSTRACT
Los tumores duodenales son menos frecuentes que los del estómago y colon. Los habituales son los carcinomas, linfomas y tumores de los estromas malignos o benignos; los pólipos duodenales suelen ser asintomáticos. Su manifestación más frecuente es la hemorragia. Las lesiones de gran tamaño pueden cursar con un cuadro suboclusivo y las periampulares producir ictericia. Se presentó el caso de una paciente de 68 años de edad, colecistectomizada que ingresa por íctero intermitente, con episodios de coluria, acolia, prurito generalizado, pérdida de peso y dolor en epigastrio, se realizó ecografía de hígado, vías biliares y páncreas en la cual se evidenció dilatación de vías biliares, se exploró endoscópicamente el duodeno y se observó una lesión sobreelevada se le realizó biopsia, diagnosticándose un adenoma de papila duodenal. La paciente fue sometida a una ampulectomía, no se observó focos de adenocarcinoma en la biopsia quirúrgica y el cuadro ictérico desapareció, no se presentaron complicaciones postoperatorias.
Duodenal tumors are less frequently than those of stomach and colon. The habitual ones are carcinomas, lymphomas and malignant or bening stromal tumors, duodenal polyps are usually asymptomatic. The haemorraghe is the most frequent sign. The great size lesions can show a suboclussive presentation and the periampullary ones can produce. A 68-year-old female patient to whom cholecystectomy was performed was presented in this article. The patient was admitted due to recurrent jaundice, episodes of dark urine, acholia, generalized pruritus, weight loss and epigastric pain. Ultrasonography of the liver, biliary tract and pancreas was performed in which bile duct dilatation was evident, duodenum was also explored and a lesion was observed. Biopsy was done and an adenoma of duodenal papilla was diagnosed. Surgical ampulectomy was performed without adenocarcinoma findings in the surgical biopsy, the jaundice disappeared and none postsurgical complication was observed.
ABSTRACT
Los tumores ampulares representan un grupo diverso aunque infrecuente de lesiones ubicadas en la confluencia de los conductos pancreático y biliar. Representan el 1-2% de los tumores del tracto digestivo, estos pueden ser benignos y malignos. Entre los tumores benignos, el adenoma es el más frecuente y su incidencia oscila entre 0,04 y 0,12%. Pueden ser sésiles o pediculados e histológicamente diferenciarse en tubulares, túbulo-vellosos y vellosos. Debido a su potencial maligno, el tratamiento recomendado es la resección bien sea quirúrgica o endoscópica; esta última indicada en tumores menores de 4,5cm. Se reporta el caso de paciente masculino de 78 años quien consultó por ictericia, dolor abdominal y pérdida de peso de 2 meses de evolución. Se realizó ultrasonido y tomografía abdominal que reportan imagen sólida en confluente biliopancreático. Se realizó duodenoscopia encontrando tumoración ampular de 6 centímetros de diámetro de aspecto velloso. Dada la edad y comorbilidades del paciente se decidió ampulectomía endoscópica parcelar. En la colangiografía retrograda endoscópica se observó imagen de defecto en tercio distal de colédoco por lo que se procedió a extraer con balón de Fogarty, obteniéndose masa tumoral de aspecto velloso pediculada la cual es resecada sin complicaciones. El hallazgo histopatológico reportó adenoma túbulo-velloso con displasia de bajo grado y en controles endoscópicos e histológicos de seguimiento a los 10 meses del procedimiento no se ha evidenciado recidiva tumoral y clínicamente el paciente se encuentra asintomático y en buenas condiciones generales
Ampullary tumors represent a various group but uncommon lesions located at the confluence of the pancreatic and bile ducts. They account for 1 to 2% of the digestive tract tumors, they may be benign and malignant. Among benign tumors, the adenoma is the most common and its incidence ranges from 0.04 a 0.12%. They can be sessile or pedunculated and histologically differentiated tubular, tubulo villous and villous. Because of its malignant potential, the recommended treatment is surgical resection or endoscopic either, the latter indicated in tumors less 4.5 cm. A case of 78 years old male patient who consulted with jaundice, abdominal pain and two months weight loss. It performed abdominal ultrasound and CT reporting in confluent biliopancreatic solid image. Duodenoscopy was performed finding ampullary tumor six inches diameter appearance fluffy. Considering patient age and comorbidities, it decided parcel endoscopic ampullectomy. In endoscopic retrograde cholangiography, defect image was observed in distal choledochal, so we proceeded to extract with Fogarty Balloon, giving pedunculated villous tumor, which is removed without complications. The histopathological finding was tubule villous adenoma, with low grade dysplasia. In endoscopic and histologycal controls up to procedure ten months, is not clinically evidence tumor recurrence and the patient is asymptomatic in good general conditions
Subject(s)
Aged , Adenocarcinoma/diagnosis , Adenocarcinoma , Ampulla of Vater/injuries , Ampulla of Vater/pathology , Endoscopy/methods , Gastroenterology , Medical OncologyABSTRACT
Ampullary neoplasms may correspond to adenoma or adenocarcinoma. The study of its staging is performed by means of computed tomography, magnetic resonance imaging and endosonography. The appropriate classification of the stages allows for a better planning of treatment. In benign tumors and small selected carcinoma, ampullectomy (endoscopic or surgical) is an alternative. In patients with ampullary neoplasms invading deep extension or showing high risk of recurrence, without evidence of metastasis, pancreatodudodenectomy is the treatment of choice. In those cases with distant metastasis, palliative treatment is indicated.
Las neoplasias ampulares pueden corresponder a adenomas o adenocarcinomas. El estudio de etapificación se realiza con tomografía computada, resonancia magnética y endosonografía. La correcta clasificación en estadíos, permite planificar de mejor forma el tratamiento. En tumores benignos y seleccionados carcinomas pequeños, la ampulectomía (endoscópica o quirúrgica) es una alternativa. En pacientes con neoplasias ampulares que presentan extensión en profundidad o alto riesgo de recurrencia, sin evidencia de metástasis a distancia, estaría indicada la pancreatoduodenectomía. En aquellos casos con metástasis a distancia, se aplican técnicas paliativas.
Subject(s)
Humans , Adenocarcinoma/surgery , Adenoma/surgery , Ampulla of Vater/surgery , Common Bile Duct Neoplasms/surgery , Adenocarcinoma/diagnosis , Adenoma/diagnosis , Ampulla of Vater/pathology , Duodenoscopy , Neoplasm Staging , Common Bile Duct Neoplasms/classification , Common Bile Duct Neoplasms/diagnosis , Pancreaticoduodenectomy , PrognosisABSTRACT
PURPOSE: Tumors arising from the ampulla of Vater can be benign or malignant. Recently, endoscopic papillectomy has been employed in the management of benign ampulla of Vater tumors; however, surgical resection is the treatment of choice. The aim of this study was to define indications and suggest a role for transduodenal ampullectomy in the management of ampulla of Vater tumors. METHODS: We retrospectively reviewed the medical records of 54 patients treated for ampulla of Vater tumors between January 1999 and December 2008. RESULTS: Twenty-two endoscopic papillectomies and 21 transduodenal ampullectomies were performed. Four patients underwent transduodenal ampullectomy after endoscopic papillectomy due to a recurrent or remnant tumor. Recurrence or a remnant tumor was found in one patient after transduodenal ampullectomy compared to six patients after endoscopic papillectomy. Immediate intraoperative conversion from transduodenal ampullectomy to pancreaticoduodenectomy was performed in five patients based on intraoperative frozen biopsy analysis. CONCLUSION: Transduodenal ampullectomy should be performed to treat ampulla of Vater tumors that are unsuitable for endoscopic papillectomy. Transduodenal ampullectomy can serve as an intermediate treatment option between endoscopic papillectomy and pancreaticoduodenectomy in the management of ampulla of Vater tumors.
Subject(s)
Humans , Ampulla of Vater , Biopsy , Medical Records , Pancreaticoduodenectomy , Recurrence , Retrospective StudiesABSTRACT
PURPOSE: Periampullary malignant tumors become symptomatic at an early stage because of their particular location. For this reason, radical resection is possible in the majority of cases. Periampullary tumors can be removed either by a local resection, as performed by Halsted in 1899, or by a radical pancreaticoduodenectomy, as performed by Whipple et al. in 1935. Both techniques have been used, and their respective places in the treatment of benign or malignant periampullary tumors has been the subject of constant debate. Therefore, we reviewed the cases of four patients who had undergone a transduodenal ampullectomy for an ampullary tumor which was confined to the ampulla of Vater. METHODS: The clinical records of 4 patients who undergone a transduodenal ampullectomy were reviewed. All patients were diagnosed as having an ampullary mass based on gastroduodenoscopy, endoscopic retrograde cholangiopancreatography, or both. Clinical presentation, comparison of pathologic findings of preoperative endoscopic biopsy, operative frozen section, final pathologic examination, complications, follow-up period, and recurrence were reviewed. RESULTS: The two men and the two women studied had a median age of 59.3 (range, 49 to 64 years). Among the four patients who underwent a transduodenal ampullectomy, an adenocarcinoma was found at final pathologic examination in two patients with preoperative diagnoses of a villotubular adenoma and a villous adenoma, respectively. The other two cases were diagnosed as tubular adenomas at final pathologic examination as they had been at the preoperative diagnosis. No evidence of disease was observed in any of the four patients on follow-up at 29 months, 30 months36 months, and 4 months. None of these patients had major complications in the immediate postoperative period, transient hyperamylasemia without clinical significance developed in two patients. CONCLUSION: The transduodenal ampullectomy is a valuable tool in the treatment of ampullary lesions. The result of local excision of the Vater for ampullary tumors appears satisfactory, and this procedure may be particularly indicated for benign tumors, as well as for older or high-risk patients whose malignant lesions are confined to the ampulla of Vater. However, the selection of this procedure required judicious decision making and precise technique and should involve an experienced team of pathologists and surgeons. As a result, for patients in whom it is indicated, a transduodenal ampullectomy is an alternative to the pancreaticoduodenectomy and has good long-term results.
Subject(s)
Female , Humans , Male , Adenocarcinoma , Adenoma , Adenoma, Villous , Ampulla of Vater , Biopsy , Cholangiopancreatography, Endoscopic Retrograde , Decision Making , Diagnosis , Follow-Up Studies , Frozen Sections , Hyperamylasemia , Pancreaticoduodenectomy , Postoperative Period , RecurrenceABSTRACT
BACKGROUND/AIMS: The resectability rate and prognosis of tumors of the ampulla of Vater are significantly better than for other periampullary tumors. Treatment for ampullary tumors has traditionally been surgical resection. However, endoscopic ampullectomy has been reported in patients with benign ampullary tumors. This study is being conducted to evaluate the availability of endoscopic ampullectomy. METHODS: Between 1994 and 1996, 6 cases (M: F=5: 1) with ampullary tumors were treated by endoscopic ampullectomy. Clinical presentations, complications, pathologic findings, and follow-up information were reviewed. RESULTS: Complete resection was perfomed in 5 cases. Pancreatitis after this procedure occurred in 2 cases, but were resolved by conservative care. Pathologic findings of resected specimens were adenama in 4 cases and adenocarcinoma in 2 cases. There was no recurrence in adenoma during the follow-up period (9-37 months) except in one case, which the patient was lost after 9 months. In one case with adenocarcinoma, the patient refused the operation, and consequently had the tumor recurrence 13 months later. CONCLUSIONS: Endoscopic ampullectomy was considered safe and effective treatment for removing benign ampullary tumors as well as malignant tumors, the latter of which are not considered suitable for operation.