[Vater's ampulla neoplasms. Diagnostic and therapeutic approach. Apropos of 18 cases]

Diagnostic and therapeutic aspects of neoplasms of the ampulla of Vater are discussed in relation to a relatively small but homogeneous series of 18 cases. The presenting sign is almost always jaundice, with or without associated manifestations of the angiocholitic type, sometimes regressive but recurrent. A rapid diagnosis should now be possible by ultrasound imaging of the dilated intra- and extra-hepatic biliary pathways, complemented by either fibroscopy with or without retrograde catheterization or trans-parieto-hepatic-cholangiography. The most effective therapy appears to be cephalic duodeno pancreatectomy, pathologic examination of fresh specimens of possible adenopathies being of doubtful interest since the presence of N + lymph nodes does not prevent prolonged life expectancy. The principal technical problem is related to the pancreatic stump, since this is formed of healthy parenchyma capable of provoking a fistula whether or not a pancreatico-digestive anastomosis has been performed. It might be possible in the future to use substances blocking the external secretion of the pancreatic stump left in place, in order to diminish the risk of fistula and its well-known consequences. Tumors of the ampulla of Vater have a relatively favorable prognosis when compared with that of other neoplasms in the biliopancreatic intersection zone, and an aggressive attitude to their therapy is therefore fully justified.