Introduction: Duodenal villous adenoma arising
from the ampulla of Vater has a high risk of malignant
development. Excluding associated malignant
disease prior to resection of an adenoma of the ampulla
is not always possible. Therefore, the surgical
procedure of choice to treat this rare tumour is still
controversial.Objective: To evaluate retrospectively results of treatment
of villous adenoma arising from ampulla of
Vater with dysplasia or associated carcinoma limited
to the ampulla.Patients and Methods: From 1985 to 1996, eight
patients have been diagnosed with ampullary villous
adenoma suitable for resection. We have reviewed
treatment, morbidity, mortality, follow-up and final
outcome.Results: Pancreatoduodenectomy (PD) was performed
in 4 patients. Transduodenal ampullectomy and
endoscopic resection was performed in 2 patients
each. There was no perioperative mortality.
None of the patients had biliary, pancreatic or intestinal
leakage but two patients who underwent
PD had minor postoperative complications. The mean
follow-up was 44 (range: 6–132) months. Villous
adenoma was associated with adenocarcinoma in
50% of the cases (4/8 patients). During the followup
both patients who underwent transduodenal
ampullectomy developed recurrent disease. All patients
initially treated by PD are alive without
evidence of recurrent disease.Conclusions: Treatment of villous adenoma of the
ampulla must be individualized within certain limits.
In our series, PD achieve good results and it appears
to be the procedure of choice in order to treat
villous adenomas with proved presence of carcinoma,
carcinoma in situ or severe dysplasia. Endoscopic
or local resection may be appropriate for small
benign tumours in high risk patients.
Ampulla of Vater Villous Adenoma
