Benign tumour of the ampulla of vater: surgical treatment and prognosis

OBJECTIVE: To find out whether wide local resection is adequate treatment for patients with benign tumours of the papilla of Vater. DESIGN: Retrospective study. SETTING: University hospital, Germany. SUBJECTS: 31 patients with benign tumours out of a total of 129 with lesions of the ampulla of Vater treated between May 1978 and February 1995. INTERVENTIONS: Histological examination of specimens before, during, and after the operation. MAIN OUTCOME MEASURES: Sensitivity and positive predictive value of histological examination, and outcome of treatment. RESULTS: Histological examination before and during the operation had a sensitivity of 89% and 97%, respectively. 28 patients were treated by wide excision of the ampulla and 3 by pylorus-preserving partial pancreaticoduodenectomy. At a median follow up of 43 months (range 6-156) there was no evidence of recurrent disease. CONCLUSION: Wide excision of the ampulla with reconstruction and reimplantation of the duct is adequate treatment for benign lesions. If the histological picture is uncertain, partial pancreaticoduodenectomy is justified in patients at low risk.