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Proposed indications for limited resection of early ampulla of Vater carcinoma: clinico‐histopathological criteria to confirm cure
Author(s) -
Aiura Koichi,
Hibi Taizo,
Fujisaki Hiroto,
Kitago Minoru,
Tanabe Minoru,
Kawachi Shigeyuki,
Itano Osamu,
Shinoda Masahiro,
Yagi Hiroshi,
Masugi Yohei,
Sakamoto Michiie,
Kitagawa Yuko
Publication year - 2012
Publication title -
journal of hepato‐biliary‐pancreatic sciences
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.63
H-Index - 60
eISSN - 1868-6982
pISSN - 1868-6974
DOI - 10.1007/s00534-011-0492-4
Subject(s) - medicine , ampulla of vater , carcinoma , ampulla , radiology , lymph node , adenocarcinoma , bile duct , endoscopic retrograde cholangiopancreatography , pancreatic duct , biopsy , pancreas , gastroenterology , pancreatitis , surgery , cancer
Background Limited resection is reserved for patients with high operative risk or benign adenomas. We aimed to define indications for limited resection of early ampulla of Vater carcinoma with curative intent through detailed preoperative examinations and histopathological evaluations. Methods We performed a retrospective cohort study of all consecutive Japanese patients who underwent resection for ampulla of Vater neoplasms at our hospital from 1986 to 2010. Results A total of 75 patients were identified. Moderately/poorly differentiated histology, lympho‐vascular/perineural invasion, and duodenal/pancreatic invasion were significant risk factors for lymph node metastases. Macroscopically, non‐exposed protruded‐ or ulcerative‐type disease did not correlate directly with lymph node metastases; however, these tumor types were associated with other invasive features. In a subset of early carcinomas fulfilling the conditions of exposed protruded adenoma or papillary/well‐differentiated adenocarcinoma determined by endoscopic biopsy, negative duodenal invasion determined by endoscopic ultrasonography, no tumor infiltration into the pancreatic duct determined by intraductal ultrasound, and diameter of the pancreatic duct ⩽3 mm determined by endoscopic retrograde cholangiopancreatography ( N = 11), the incidence of lymph node metastasis and tumor infiltration into the pancreatic duct was 0%. Conclusion Strictly selected patients with early ampulla of Vater carcinomas may benefit from limited resection if the resected specimen is evaluated to confirm all histopathological criteria.