PAPILLODUODENECTOMY IN THE TREATMENT OF T UMORS OF THE AMPULLA OF VATER

Ampoulectomy is rarely used for exeresis of tumours of the Oddi ampoul a due to the risk of incomplete exeresis and postoperative complicatio ns. We performed 10 ampoulectomies between 1981 and 1990 (8 males, and 2 females: mean age 59 years). The operative procedure included wide resection followed by reimplantation of the biliary and pancreatic can als. The operative indications were based on converging evidence profi ced by pathological examination of pre- and peroperative biopsies. The re were 4 adenomas, 2 villous tumours, 2 ectopic pancreases, 1 somatos tatinoma and 1 villous tumour with in situ carcinoma. Post-operative m ortality was nil: the only post-operative complication was 1 stress ul cer. In one case, the benign nature of the tumour was infirmed by the pathological examination of the surgical specimen (invasive adenocarci noma). This patient refused duodenopancreatectomy and died at recurren ce 72 months later. For the other patients, mean post-operative follow -up was 60 months. Clinical, biological, endoscopic and pathological f ollow-up have not revealed relapse in any of the other patients. These results show that complete exeresis of benign Oddi tumors can be achi eved by ampoulectomy without specific post-operative complications. Pr ogress in echoendoscopy will probably lead to very precise evaluation of the local invasion of these tumours and thus to wider indications a nd better follow-up in operated patients.