Adenocarcinoma of the Ampulla of Vater Diagnosis and Treatment

Abstract

Patients (51) underwent operation for adenocarcinoma of the ampulla of Vater. Seven patients underwent palliative bypass with an operative mortality of 28.6%; 44 additional patients underwent potentially curative pancreaticoduodenal resection (PDR) with an operative mortality of 15.9%. Postoperative complications occurred in 63% of patients. Postoperative gastrointestinal bleeding was observed in 11 of 44 patients who underwent PDR (25%). Although anastomotic ulcers (AU) were directly implicated in 5 cases (45%), the 12% incidence of AU-related bleeding among 33 patients who underwent PDR without truncal vagotomy (TV) was not significantly different from the 9% incidence observed in 11 patients who underwent PDR plus TV. Performance of TV appeared to result in a higher incidence of postoperative pulmonary complications. Five patients who underwent curative resection survived for 5 yr (11%). Only 1 of 7 patients who underwent palliative bypass survived 3 yr (14%) and none survived to 5 yr. Acceptable survival rates following resectional therapy warrant an aggressive approach to this tumor. TV may increase postoperative patient morbidity without actually providing any protection from anastomotic ulceration.