LOCAL RESECTION FOR AMPULLARY TUMORS - IS THERE A PLACE FOR IT

Two of 14 patients with adenomas were without disease 25 and 43 months after ampullary resection. Two patients with an initial diagnosis of malignant neoplasm had no recurrence at 75 and 40 months; one underwen t pancreatoduodenectomy at 8 months because of recurrence. Six of nine patients with initial diagnoses of villous adenoma were without disea se at 1, 2, 16, 23, 46, and 51 months; three underwent conversion to p ancreatoduodenectomy because of invasive carcinoma. Frozen-section stu dies revealed adenocarcinoma in two patients with villous adenoma but failed to show invasion in one patient. One patient with villous adeno ma was mistakenly thought to have carcinoma based on results of frozen -section studies. Local ampullary resection is valuable in treating be nign and selected premalignant and malignant ampullary lesions. The th reshold for conversion to pancreatoduodenectomy should be low unless a mpullectomy is performed with palliative intent.