Benign tumours of the papilla of Vater

Background and objective: Villous adenoma is the most common tumour of the papilla of Vater, and transition from adenoma to carcinoma is now generally accepted as proven. It is thus essential for an adenoma to be removed, Met hods of removal have ranged from endoscopic sling papillectomy to partial d uodenopacreatectomy. It was the aim of this study to determine whether recu rrence can be prevented by local resection. Patients and methods: 58 patients with a benign tumour of the papilla (26 m en, 32 women; average age 59 [range from 18 to 81] years) were included. De pending on preoperative histology, intraoperative frozen-section diagnosis and macroscopic histopathology, some form of surgical intervention was unde rtaken, most often resection of the ampulla. The clinical course and findin gs at postoperative follow-up were recorded and the absence of recurrence c hecked by endoscopy. Results: Ampullectomy was performed in 49 of the 58 patients, papillectomy in three. Although frozen-section examination had failed to reveal any mali gnancy, resection of the head of the pancreas with preservation of the pylo rus was done in six patients, carcinoma having been suspected macroscopical ly. There were no operative deaths. An adenoma had been found in 44 patient s, one quarter of them showing severe dysplasia: follow-up examinations aft er a mean interval of 45 months (range of 6-180 months) failed to find any recurrence. Conclusion: Ampullectomy provides an adequate surgical treatment of benign adenoma of the ampulla of Vater. Accurate surgical technique and pre-, intr a- and final histopathological diagnosis by an experienced pathologist are decisive factors in determining the ultimate outcome. If the histological f indings as to benignity are unclear, resection of the head of the pancreas with preservation of the pylorus by an experienced surgeon is indicated.