Diagnostik und Therapie des Papillentumors

BACKGROUND AND OBJECTIVE Complete removal of tumours of the ampulla (papilla) of Vater is generally recommended, because of the known adenoma-carcinoma sequence yet the uncertainty regarding diagnosis of dignity of such tumours. The aim of this study was tho analyse different treatment concepts on the basis of data from a personal series of cases. PATIENTS AND METHODS Clinical, laboratory and histological data as well as treatment and course in nine patients (three women, six men; mean age 62 [46-82] years) with ampulla of Vater adenoma, treated at one hospital, were analysed retrospectively. The patients had been followed for 6-36 months. RESULTS All tumours had been removed endoscopically. Partial duodenopancreatectomy had subsequently been performed in two patients because of severe dysplasia. One tumour with moderately severe dysplasia had recurred locally within two months of endoscopic removal and was resected transduodenally. There had been no further recurrences 3 to 36 months later. CONCLUSION If there is no evidence of malignity and frequent follow-up can be ensured, endoscopic removal of a tumour of the ampulla of Vater is justified. Otherwise transduodenal excision of the ampulla or partial duodenopancreatectomy should be undertaken.