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Vessel-sparing Excision and Primary Anastomosis

Vessel-sparing Excision and Primary Anastomosis

Published on: January 7, 2019

Surgical ampullectomy: A comprehensive review.

Darren L Scroggie¹, Vasileios K Mavroeidis²

¹Department of Population Health Sciences, Bristol Centre for Surgical Research, Bristol Medical School, Bristol BS8 2PS, United Kingdom.

World Journal of Gastrointestinal Surgery

|December 24, 2021

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Surgical ampullectomy (SA) for ampullary tumours offers favourable outcomes in selected cases, though evidence is limited. Further research is needed to clarify its role alongside pancreatoduodenectomy (PD) and endoscopic papillectomy (EP).

Area of Science:

Gastroenterology
Surgical Oncology
Digestive System Tumours

Background:

Ampullary tumours are uncommon digestive system lesions, often diagnosed early due to duct obstruction.
Surgical ampullectomy (SA) was an early treatment, later superseded by pancreatoduodenectomy (PD) and endoscopic papillectomy (EP).
Current treatment for resectable ampullary tumours predominantly involves PD or EP, with SA's role debated.

Purpose of the Study:

To review the current role of surgical ampullectomy (SA) in managing ampullary tumours.
To explore indications, controversies, and comparative outcomes of SA versus other treatments.
To identify potential future research directions for establishing evidence-based guidelines.

Main Methods:

Comprehensive literature review of studies reporting surgical ampullectomy for ampullary lesions.

Keywords:

Ampulla of Vater Ampullary tumours Endoscopic papillectomy Pancreatoduodenectomy Surgical ampullectomy Transduodenal ampullectomy

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Analysis of observational studies due to the absence of randomized controlled trials.

Exploration of heterogeneity in study methodologies and patient/tumour characteristics.

Main Results:

SA may offer favourable peri-operative and long-term outcomes with low mortality in carefully selected patients.
Meaningful comparisons between SA, PD, and EP are challenging due to study heterogeneity.
SA remains relevant for specific benign entities and potentially early-stage ampullary cancers.

Conclusions:

The precise indications for SA in ampullary tumour management require further clarification.
Well-designed observational studies are crucial for generating comparative evidence.
The findings may inform the development of future consensus guidelines for SA use.