Long-term results of surgical treatment of Vater's ampulla neoplasms.

BACKGROUND/AIMS: Vater's ampulla neoplasms account for 30% of resected bilio-pancreatic confluent tumors. Study aim was to review long-term results of surgical treatment for ampullary neoplasms.

METHODOLOGY: A retrospective review from 1993 to 2002 identified 55 patients admitted for Vater's ampulla neoplasm in our institution. Follow-up was complete for all cases with a median follow-up of 24 (range 2-180) months.

RESULTS: Among the ampullary neoplasms, 10 were adenomas (median age 71) and 45 adenocarcinomas (median age 69). Of the adenomas 60% were treated surgically with excellent long-term results. The resectability rate of ampullary carcinomas was 84%. 34 patients had pancreaticoduodenectomy and 4 ampullectomy. Importantly, the rate of false-negative preoperative biopsies was 45%. Seven patients were treated by stenting or derivation due to poor condition. Actuarial five-year survival rate after pancreatoduodenectomy was 68% (median follow-up 24 months), compared to 0% for other approaches (p < 0.01). After pancreatoduodenectomy, the lymph node status influenced survival, while disease-free survival at 5 years was 85% for NO and 27% for N1 (p < 0.001). Among the pancreatoduodenectomies, 55% consisted of pylorus-preserving procedure which did not influence prognosis compared to absence of pylorus preservation.

CONCLUSIONS: Pancreatoduodenectomy remains the gold standard for Vater's ampulla neoplasms resection due to the low sensitivity of diagnostic biopsies for carcinoma detection. Vater's ampulla neoplasms resection by pancreatoduodenectomy is associated with good long-term results; however survival after curative resection is influenced by lymph node status.