[Benign tumors of the Vater's papilla]

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. Methods of removal have ranged from endoscopic sling papillectomy to partial duodenopancreatectomy. It was the aim of this study to determine whether recurrence can be prevented by local resection.

58 patients with a benign tumour of the papilla (26 men, 32 women; average age 59 [range from 18 to 81] years) were included. Depending on preoperative histology, intraoperative frozen-section diagnosis and macroscopic histopathology, some form of surgical intervention was undertaken, most often resection of the ampulla. The clinical course and findings at postoperative follow-up were recorded and the absence of recurrence checked by endoscopy.

Ampullectomy was performed in 49 of the 58 patients, papillectomy in three. Although frozen-section examination had failed to reveal any malignancy, resection of the head of the pancreas with preservation of the pylorus was done in six patients, carcinoma having been suspected macroscopically. There were no operative deaths. An adenoma had been found in 44 patients, one quarter of them showing severe dysplasia: follow-up examinations after a mean interval of 45 months (range of 6-180 months) failed to find any recurrence.

Ampullectomy provides an adequate surgical treatment of benign adenoma of the ampulla of Vater. Accurate surgical technique and pre-, intra- and final histopathological diagnosis by an experienced pathologist are decisive factors in determining the ultimate outcome. If the histological findings as to benignity are unclear, resection of the head of the pancreas with preservation of the pylorus by an experienced surgeon is indicated.