DIAGNOSIS AND THERAPY FOR AMPULLARY TUMORS - 63 CASES

From 1970 to 1992 a total of 63 patients underwent operation for ampul lary tumor: 40 pancreatoduodenectomies (PDs), 3 total PDs, 8 ampullect omies, and 12 bypass or exploratory laparotomies. The resectability ra te was 68%. There were 9 benign tumors, 1 anaplastic tumor, and 53 ade nocarcinomas. According to Martin's classification, there were 7 stage I, 11 stage II, 14 stage III, and 21 stage TV tumors. All patients wi th stage I, II, and III tumors underwent resection. Patients with stag e TV tumors had either resection (n = 11) or bypass (n = 10), The mean duration of hospital stay was 20.6 days. Operative mortality was 12.7 % for the whole series and 7.5% after PD (2.5% for the last 10 years). Overall survival was 40% at 5 years (85% for stage I, 65% for stage I I, 44% for stage III, and 8% for stage IV. Survival was better for sta ges I, II, and III after PD than after ampullectomy. For stage TV pati ents survival was 70% after PD versus 20% after bypass at 1 year and 2 5% versus 0% after 2 gears. In our opinion, PD should be proposed even for benign lesions because two of our patients had to undergo repeat operation (PD) 4 and 22 years later, respectively, for stage IV diseas e. PD is our choice for all tumors of the ampulla.