IS LOCAL EXCISION OF PT1-AMPULLARY CARCINOMAS JUSTIFIED

We propose that local excision of carcinomas of the ampulla of Vater i s justifiable under the following conditions: when the tumour is limit ed to the ampulla of Vater as diagnosed by pre-operative endoluminal s onography (uT1) and UICC-staging (pT1); and when it is graded G1 or G2 and there is no lymphatic infiltration and the tumour is completely r esected (R0). Under these conditions peri-operative morbidity and mort ality were significantly reduced compared with more extensive surgery. There was no local recurrence of tumour in our study and long-term su rvival rates were comparable with Whipple's procedure. This implies th at lymphatic spread is limited in localized disease and the feasibilit y of the proposed procedure may therefore be analogous to localized re sections in other malignant tumours, e.g. carcinoma of the rectum.