Transduodenal ampullectomy in the treatment of villous adenomas and adenocarcinomas of the Vater's ampulla.

INTRODUCTION Adenomas are the most frequent tumors of the Vater s ampulla. Their capacity for malignant transformation following the adenoma-carcinoma sequence is well known. It is because of this that resection after diagnosis is required. The identification of the appropriate technique according to tumor features would require that patients not be undertreated or overtreated, which would give rise to serious consequences derived from their location. PATIENTS AND METHODS Villous adenomas and adenocarcinomas of the Vater s ampulla candidates for local resection were revised from January 1st, 1998 through June 30th, 2003. We describe the methods of diagnosis and ampulectomy techniques we performed. RESULTS We performed an ampulectomy by first intention in all 8 patients included in this study. However, pancreatoduodenectomy was necessary in two patients because of the closeness of resection margins. We had no mortality in this series, and morbidity was limited to two episodes of digestive bleeding that were controlled by electrocoagulation and embolization. The mean follow-up was 28.5 months (range, 6-72 months). CONCLUSIONS The difficulty of precise preoperatory diagnosis in adenomas of the Vater s ampulla demands resection after identification. Ampulectomy is the treatment of choice for villous adenomas and T1 adenocarcinomas, with 1 cm of resection margin to avoid local recurrence.