Treatment Options for Villous Adenoma of the Ampulla of Vater

Introduction: Duodenal villous adenoma arisingfrom the ampulla of Vater has a high risk of malignantdevelopment. Excluding associated malignantdisease prior to resection of an adenoma of the ampullais not always possible. Therefore, the surgicalprocedure of choice to treat this rare tumour is stillcontroversial.Objective: To evaluate retrospectively results of treatmentof villous adenoma arising from ampulla ofVater with dysplasia or associated carcinoma limitedto the ampulla.Patients and Methods: From 1985 to 1996, eightpatients have been diagnosed with ampullary villousadenoma suitable for resection. We have reviewedtreatment, morbidity, mortality, follow-up and finaloutcome.Results: Pancreatoduodenectomy (PD) was performedin 4 patients. Transduodenal ampullectomy andendoscopic resection was performed in 2 patientseach. There was no perioperative mortality.None of the patients had biliary, pancreatic or intestinalleakage but two patients who underwentPD had minor postoperative complications. The meanfollow-up was 44 (range: 6–132) months. Villousadenoma was associated with adenocarcinoma in50% of the cases (4/8 patients). During the followupboth patients who underwent transduodenalampullectomy developed recurrent disease. All patientsinitially treated by PD are alive withoutevidence of recurrent disease.Conclusions: Treatment of villous adenoma of theampulla must be individualized within certain limits.In our series, PD achieve good results and it appearsto be the procedure of choice in order to treatvillous adenomas with proved presence of carcinoma,carcinoma in situ or severe dysplasia. Endoscopicor local resection may be appropriate for smallbenign tumours in high risk patients.