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[Ampullary neoplasms: surgical management].

Martin Schneider1, Markus W Büchler2

  • 1Klinik für Allgemein‑, Viszeral- und Transplantationschirurgie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 420, 69120, Heidelberg, Deutschland. martin.schneider@med.uni-heidelberg.de.

Der Chirurg; Zeitschrift Fur Alle Gebiete Der Operativen Medizen
|July 14, 2021
PubMed
Summary

Surgical resection is necessary for unresectable ampullary tumors. Treatment selection depends on tumor type, size, and spread, impacting prognosis and survival outcomes for ampullary neoplasms.

Keywords:
Ampullary adenomaAmpullary carcinomaPapillectomyPartial pancreatoduodenectomyTransduodenal ampullectomy

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Area of Science:

  • Gastroenterology
  • Surgical Oncology
  • Hepatobiliary Surgery

Background:

  • Ampullary tumors (adenomas and carcinomas) of the greater duodenal papilla require surgical intervention when unresectable endoscopically.
  • Surgical approaches must be tailored to tumor size, local invasion, and growth patterns.

Purpose of the Study:

  • To review current scientific literature on the indications, strategies, and dissection techniques for surgical resection of ampullary tumors.
  • To provide an overview of evidence-based recommendations for managing ampullary neoplasms.

Main Methods:

  • A comprehensive literature review was conducted focusing on the surgical management of ampullary neoplasms.
  • Current evidence and clinical recommendations were systematically summarized.

Main Results:

  • Ampullary neoplasms exhibit diverse origins (intestinal or pancreatobiliary) and histopathological subtypes, influencing therapeutic strategies.
  • Ampullary adenomas warrant resection due to malignant transformation risk; techniques include endoscopic papillectomy, transduodenal ampullectomy, and partial pancreatoduodenectomy.
  • Ampullary carcinoma necessitates upfront pancreatoduodenectomy with lymph node and mesopancreas dissection.

Conclusions:

  • Histopathological differentiation is critical for ampullary adenocarcinoma treatment and prognosis.
  • Procedure selection for adenomas hinges on tumor characteristics like intraductal extension, size, and dysplasia.
  • Lymph node status and perineural invasion are significant prognostic indicators for ampullary carcinoma survival.