Abstract
Adenocarcinoma is the most common malignant tumor of the ampulla, but in general, it is still rare. Therefore, these tumors are difficult to study, and most reports are of retrospective design. To evaluate immediate postoperative and long-term results, we have collected data prospectively in a specially created database on 21 consecutive patients with adenocarcinoma of the papilla of Vater, operated on at the Department of Surgery, Kaunas University of Medicine Hospital. All patients have undergone classical or pylorus-preserving pancreatoduodenectomy. Postoperative mortality was 4.8% and overall morbidity – 28.6%. Pancreas-associated morbidity was 14.3% in the series. Actuarial 3-year survival among our patients was 89%. Stage I–II patients with T1–T2 and/or N negative tumors had significantly better 3-year survival when compared with stage III–IV patients, T3–T4 and/or N positive tumors. Patients with highly or moderately differentiated tumors (G1, G2) survived better than patients with poor cell differentiation (G3), though significant difference was not achieved. Results are satisfactory in terms of overall postoperative morbidity and mortality. Long-term survival pattern concerning T, N, and G status corresponds with other reports in literature, while the 3-year survival results are promising and speaks in favor of our surgical strategy.
Highlights
The anatomy of the ampulla of Vater is very complex
Long-term survival pattern concerning T, N, and G status corresponds with other reports in literature, while the 3-year survival results are promising and speaks in favor of our surgical strategy
It is generally agreed that adenocarcinoma of papilla of Vater should be removed by partial pancreatoduodenectomy, whereas local ampullectomy with local lymphadenectomy should be reserved for pTis and pT1N0M0G1 or G2 tumors [4]
Summary
The anatomy of the ampulla of Vater is very complex. It consists of three different epithelia (bile duct, pancreatic duct, and duodenum). The frequency of malignant lesion in an adenoma of the papilla is about 26% [4]. Carcinomas of papilla of Vater have been reported in 0.2% of cases [5]. It is generally agreed that adenocarcinoma of papilla of Vater should be removed by partial pancreatoduodenectomy, whereas local ampullectomy with local lymphadenectomy should be reserved for pTis and pT1N0M0G1 or G2 tumors [4]. Adenocarcinoma is the most common malignant tumor of the ampulla, but in general, it is still rare. That is why these tumors are very difficult to study, and most reports considering ampullary tumors are of retrospective design
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