Local resection or pancreaticoduodenectomy for villous adenoma of the ampulla of Vater diagnosed before operation

被引:89
作者
Cahen, DL
Fockens, P
deWit, LT
Offerhaus, GJA
Obertop, H
Gouma, DJ
机构
[1] UNIV AMSTERDAM, ACAD MED CTR, DEPT SURG G4, NL-1105 AZ AMSTERDAM, NETHERLANDS
[2] UNIV AMSTERDAM, ACAD MED CTR, DEPT GASTROENTEROL, NL-1105 AZ AMSTERDAM, NETHERLANDS
[3] UNIV AMSTERDAM, ACAD MED CTR, DEPT PATHOL, NL-1105 AZ AMSTERDAM, NETHERLANDS
关键词
D O I
10.1002/bjs.1800840711
中图分类号
R61 [外科手术学];
学科分类号
摘要
Background Treatment of ampullary adenoma is complicated by difficult preoperative staging, malignant potential and a high recurrence rate. This study was designed to assess the accuracy of diagnosis and staging by endoscopic biopsy and endosonography, and to compare the results of local resection and pancreaticoduodenectomy (Whipple procedure). Methods All 23 patients, diagnosed by endoscopic biopsy and surgically treated by local resection (n = 12) or pancreaticoduodenectomy (n = 11) between 1984 and 1994, were analysed retrospectively. Results Pancreaticoduodenectomy was associated with more complications (seven of 11 patients versus three of 12) and a longer hospital slay (36 versus 18 days) than local resection. After local resection tumour excision was incomplete in half of the patients. One patient died after a Whipple procedure. Endoscopic biopsy did not identify infiltrating carcinoma in seven of the 23 patients, Endoscopic ultrasonography had a 44 per cent accuracy rate for tumour invasion and was false positive for lymph node metastases in five of 16 patients. After local resection one recurrence was observed during follow-up and one possibly died from tumour recurrence. Conclusion Diagnosis and staging of ampullary adenomas by endoscopic biopsy and endosonography was unreliable. Local resection seems a viable alternative for patients whose general condition does ndt allow a Whipple procedure.
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页码:948 / 951
页数:4
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