Introduction. The most common benign ampullary tumors are adenomas (80 %).
They are considered as premalignant lesions with a transformation rate to c
arcinoma of up to 30 %. Methods: From 1 January 1997 to 28 February 1999 we
treated 11 patients with adenoma of the ampulla of Vater. An ampullectomy
was performed in 10 cases. One poor-risk patient could not be operated on.
Results: No operative mortality occurred. In two patients a pT1 adenocarcin
oma was diagnosed postoperatively. One of the two patients with a high-risk
carcinoma underwent a second operation, a Whipple pancreatoduodenectomy. N
ine of 10 patients had no recurrence with a median follow-up of 12 months.
Conclusion: One patient died of glioblastoma. We would therefore recommend
ampullectomy as the first-line treatment for benign tumors of the ampulla o
f Vater. In low-risk pT1 carcinoma (G1/G2, L0) and R0 resection, local exci
sion is acceptable. In high-risk pT1 carcinoma (G3 and/or L1) Whipple pancr
eatoduodenectomy is mandatory.