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The management of tumors of the ampulla of Vater by local resection.

Publication ,  Journal Article
Branum, GD; Pappas, TN; Meyers, WC
Published in: Ann Surg
November 1996

OBJECTIVE: The authors report on indications and results of local excision of tumors of the ampulla of Vater. SUMMARY BACKGROUND DATA: Local excision of ampullary tumors has been performed for nearly a century but remains controversial. The use of this procedure for benign conditions is clear, but its place, if any, in the management of ampullary malignancy is debated. METHODS: The presentation, evaluation, and treatment of 26 patients who underwent local resection of ampullary tumors between January 1987 and November 1994 are reviewed. RESULTS: There were 16 men and 10 women, with a median age of 58 years. Eighteen patients had adenomas, whereas 8 patients had adenocarcinomas. Patients presented predominantly with jaundice (50%), pain (35%), and pancreatitis (27%) and were evaluated with endoscopic retrograde cholangiopancreatography and biopsy. All patients with benign lesions had accurate preoperative biopsies. Two of eight patients shown intraoperatively to have malignant lesions had preoperative biopsies read as benign. There were no deaths. Postoperative complications included two wound infections and one episode each of cholangitis, lower gastrointestinal bleeding, and adhesive gastrointestinal obstruction. All patients had prompt resolution of jaundice if present before surgery, and the mean postoperative stay was 7.5 days. Six of eight patients with malignant lesions have had recurrent disease. CONCLUSIONS: Local excision of malignant ampullary tumors is effective palliative therapy when the patient is unfit for the Whipple procedure. Ampullary resection usually is curative for patients with benign lesions without a polyposis syndrome. In this series, intraoperative frozen section routinely was accurate.

Duke Scholars

Published In

Ann Surg

DOI

ISSN

0003-4932

Publication Date

November 1996

Volume

224

Issue

5

Start / End Page

621 / 627

Location

United States

Related Subject Headings

  • Surgical Procedures, Operative
  • Surgery
  • Middle Aged
  • Male
  • Humans
  • Follow-Up Studies
  • Female
  • Common Bile Duct Neoplasms
  • Ampulla of Vater
  • Aged
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Branum, G. D., Pappas, T. N., & Meyers, W. C. (1996). The management of tumors of the ampulla of Vater by local resection. Ann Surg, 224(5), 621–627. https://doi.org/10.1097/00000658-199611000-00006
Branum, G. D., T. N. Pappas, and W. C. Meyers. “The management of tumors of the ampulla of Vater by local resection.Ann Surg 224, no. 5 (November 1996): 621–27. https://doi.org/10.1097/00000658-199611000-00006.
Branum GD, Pappas TN, Meyers WC. The management of tumors of the ampulla of Vater by local resection. Ann Surg. 1996 Nov;224(5):621–7.
Branum, G. D., et al. “The management of tumors of the ampulla of Vater by local resection.Ann Surg, vol. 224, no. 5, Nov. 1996, pp. 621–27. Pubmed, doi:10.1097/00000658-199611000-00006.
Branum GD, Pappas TN, Meyers WC. The management of tumors of the ampulla of Vater by local resection. Ann Surg. 1996 Nov;224(5):621–627.

Published In

Ann Surg

DOI

ISSN

0003-4932

Publication Date

November 1996

Volume

224

Issue

5

Start / End Page

621 / 627

Location

United States

Related Subject Headings

  • Surgical Procedures, Operative
  • Surgery
  • Middle Aged
  • Male
  • Humans
  • Follow-Up Studies
  • Female
  • Common Bile Duct Neoplasms
  • Ampulla of Vater
  • Aged