Local excision of ampullary carcinoma

Pancreaticoduodenectomy is widely and reasonably regarded as the treatment of choice for ampullary carcinoma. Reported cases of local excision are few and mainly involve elderly, poor risk patients. Eight patients with ampullary carcinoma treated by local excision are presented. None of these patients who had local excision were considered unfit for pancreaticoduodenectomy. There were two post-operative deaths (25%). Median survival was 57 months with 44% five year actuarial survival. Three of the patients who survived the local excision subsequently developed recurrent disease. If local excision is performed some form of biliary bypass may be advisable.