Long-term Result of Surgery for Ampullary Carcinoma -Possibility of Minimum Invasive Surgery-

Gaku Matsumoto, Takashi Tsuchiya, Kosuke Arai, Ryoichi Anzai, Masanori Takahashi, Naotaka Fujita^*, Hiroshi Noda^* and Tadashi Yamazaki

Department of Surgery and Internal Gastroenterology^*, Sendai City Medical Center

Thirty-six patients with ampullary carcinoma who underwent surgical resection were examined. Thirty patients underwent pancreatoduodenectomy, and 5 patients underwent pylorus preserving pancreatoduodenectomy (PpPD). The over all five year survival rate was 66.6%. Histopathological factors influencing survival were lymph node involvement, invasion to the pancreas, invasion to the lymphatic vessels and macroscopic appearance of tumor (ulcerative or non-ulcerative type). Among these factors, invasion to the pancreas and its macroscopic appearance can be diagnosed precisely by preoperative endoscopy and endoscopic ultrasonography. There were 17 patients without invasion to the pancreas and with non-ulcerative type tumor. All of these patients showed no lymph node involvement and no recurrence of disease. These data suggest that PpPD with D₁ lymph node dissection may be applied in patients with non-ulcerative type tumors and without invasion to the pancreas. However, ampullary resection should not be applied in these patients, because 21% of them were not the early ampullary cancer.

Key words
ampullary carcinoma, invasion to the pancreas, macroscopic appearance, endoscopic ultrasonography, minimum invasive surgery

Reprint requests
Takashi Tsuchiya Department of Surgery, Sendai City Medical Center 5-22-1 Tsurugaya, miyagino-ku, Sendai, 983-0824 JAPAN

Accepted
February 24, 1999

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