A single-institution review of 157 patients presenting with benign and malignant tumors of the ampulla of Vater: Management and outcomes

John R. Hornick, Fabian Johnston, Peter O. Simon, Morgan Younkin, Michael Chamberlin, Jonathan B. Mitchem, Riad R. Azar, David C. Linehan, Steven M. Strasberg, Steven A. Edmundowicz, William G. Hawkins

Research output: Contribution to journalReview article

Abstract

Background: Although benign ampullary tumors are removed endoscopically, due to their potential to progress to malignant disease, the favored treatment for adenocarcinoma is pancreaticoduodenectomy. We reviewed our institution's experience in order to identify which patients were at highest risk of disease progression following surgical resection, as well as evaluate whether localized T1 tumors are best treated by pancreaticoduodenectomy. Methods: We retrospectively reviewed 157 patients who presented with an ampullary mass, from 2001 to 2010, and identified 51 with benign adenoma and 106 with adenocarcinoma. Results: Patients with malignant tumors most often presented with larger tumors and jaundice, which alone was predictive of survival (OR = 67). Forty-five percent of patients with pathologically confirmed T1 tumors had positive lymph nodes and median survival was modest at 60 months. Lymph node involvement was predictive of recurrence and decreased survival. Conclusion: Patients with malignant tumors often present with jaundice and larger tumors. These findings should warrant suspicion for cancer and expedited preoperative workup. Based on our finding that nearly half the patients with T1 tumors had positive lymph nodes, we recommend pancreaticoduodenectomy for any patient with biopsy proven adenocarcinoma who is a suitable candidate for surgery.

Original languageEnglish (US)
Pages (from-to)169-176
Number of pages8
JournalSurgery
Volume150
Issue number2
DOIs
StatePublished - Aug 2011
Externally publishedYes

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Ampulla of Vater
Neoplasms
Pancreaticoduodenectomy
Adenocarcinoma
Lymph Nodes
Jaundice
Survival
Adenoma
Disease Progression
Biopsy
Recurrence

ASJC Scopus subject areas

  • Surgery
  • Medicine(all)

Cite this

A single-institution review of 157 patients presenting with benign and malignant tumors of the ampulla of Vater : Management and outcomes. / Hornick, John R.; Johnston, Fabian; Simon, Peter O.; Younkin, Morgan; Chamberlin, Michael; Mitchem, Jonathan B.; Azar, Riad R.; Linehan, David C.; Strasberg, Steven M.; Edmundowicz, Steven A.; Hawkins, William G.

In: Surgery, Vol. 150, No. 2, 08.2011, p. 169-176.

Research output: Contribution to journalReview article

Hornick, JR, Johnston, F, Simon, PO, Younkin, M, Chamberlin, M, Mitchem, JB, Azar, RR, Linehan, DC, Strasberg, SM, Edmundowicz, SA & Hawkins, WG 2011, 'A single-institution review of 157 patients presenting with benign and malignant tumors of the ampulla of Vater: Management and outcomes', Surgery, vol. 150, no. 2, pp. 169-176. https://doi.org/10.1016/j.surg.2011.05.012
Hornick, John R. ; Johnston, Fabian ; Simon, Peter O. ; Younkin, Morgan ; Chamberlin, Michael ; Mitchem, Jonathan B. ; Azar, Riad R. ; Linehan, David C. ; Strasberg, Steven M. ; Edmundowicz, Steven A. ; Hawkins, William G. / A single-institution review of 157 patients presenting with benign and malignant tumors of the ampulla of Vater : Management and outcomes. In: Surgery. 2011 ; Vol. 150, No. 2. pp. 169-176.
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