Transduodenal ampullectomy for ampullary mass: one surgeon's experience

Abstract

Introduction: Ampulla of Vater (AOV) mass, especially benign lesion, has been treated with endoscopic ampullectomy in many centers. However, surgical resection for AOV mass is the treatment of choice. Traditionally, pancreaticoduodenectomy (PD) has been performed for AOV mass. However, due to the high risk of postoperative complications, transduodenal ampullectomy (TDA) has recently received attention as a method of treatment for AOV mass. Methods: We reviewed the medical records of 25 patients diagnosed as AOV mass and underwent TDA from March 2013 to June 2017. Results: All 25 patients underwent TDA, and 3 of them converted to PPPD due to intraoperative frozen biopsy results. (2 for presence of cancer in margin, 1 for regional lymph node metastasis) Of the 25 patients, 10 were diagnosed with malignancy and 15 were diagnosed with benign lesions. Of the 10 patients who were diagnosed as malignancy in postoperative biopsy, only 2 patients (20%) were diagnosed with malignancy on preoperative endoscopic biopsy. In 7 patients who underwent TDA for malignancy, there was no recurrence during the follow-up period. (mean: 44.7 months, range: 5–133) Conclusion: TDA is treatment of choice for patients who are unsuitable AOV mass for endoscopic ampullectomy and may be considered as an alternative operation in highly selective patients -histologic well diffentiation, polypoid lesion and high risk group of operation- with early ampullary cancer (Tis and T1). Further studies on consensus of TDA indication for early ampullary cancer will be needed in the future.