Long-term results of pancreaticoduodenectomy and endoscopic resection in the treatment of early stage carcinoma of the ampulla of Vater: case series and review of the literature

We retrospectively evaluated 6 cases to explore the role of curative pancreaticoduodenectomy and endoscopic resection of ampulla of Vater tumors. Six patients diagnosed with stage 1 ampullary tumors at Ankara University Hospital between January 1994 and September 2009 were analyzed retrospectively. Icterus was the cardinal symptom in all patients. The median time for the symptoms caused by the lesion of the papilla was 7 weeks in patients with carcinoma. The diameters of the visualized tumors were less than 20 mm. Diabetes mellitus was observed in 2 patients. When the patients were classified according to TNM staging, all patients were in stage 1. Endoscopic resection was performed in 3 patients, and the other 3 patients underwent curative pancreaticoduodenectomy. The mean ages in the curative pancreaticoduodenectomy group and endoscopic resection group were 54.3 and 80.3 years, respectively. Tumor recurrence was not observed in any patient. Among the endoscopic resection group, there was no sign of tumor recurrence for 72 months in 1 patient, 6 months in another patient, and 46 months in the last patient. One of the patients died 46 weeks after endoscopic ampullectomy. This patient also had diabetes mellitus and cardiac problems. Radical pancreaticoduodenectomy is presently the most common method for resecting malignant ampullary tumors. Endoscopic resection of carcinoma of the ampulla of Vater appears to be an alternative to surgical therapy, particularly in patients for whom surgical approach carries a high risk.