Segmental Resection of the Duodenum for Early Cancer of Papilla of Vater

Masanori Ishii, Toshihide Imaizumi, Hiroyuki Kashiwagi, Shouichi Douwaki, Yoshinori Sugio, Kousuke Tobita, Yasuo Otani, Kyoji Ogoshi, Hiroyasu Makuuchi and Takao Machimura*

Department of Gastroenterological Surgery, Tokai University School of Medicine
Department of Surgery, Ikegami General Hospital*

Segmental resection of the duodenum has been reported in only several facilities in Japan. We report two cases of adenocarcinoma of the ampulla of vater, which were treated safely by segmental resection of the duodenum sparing the pancreas. In recent years there are four different procedures in the surgical management for ampullary tumors, Endscopic ampullectomy, transduodenal ampullectomy, segmental resection of the duodemum, and pancreaticoduodenectomy. We determined that segmental resection of the duodenum was an appropriate operation for focal cancer of ampulla, because the first two procedures result in high recurrence and complication rates, and pancreaticoduodenectomy is too invasive. Indications for the procedure have been reported as duodenal polyps, duodenal lyomyosarcoma, Crohn' disease, lypomas, gastrointestinal tumors, ampullary adenomas and adenocarcinomas invading only the mucosa. In both our cases, the adenomas were still in the early stage and the resection was considered to be complete microscopically, with no lymph nodes metastasis present around the pancreas head. No major complications were encountered except delayed gastric emptying for two weeks, and two months after the operation the patients'weight returned to the preoperative status.

Key words
segmental resection of the duodenum, adenocarcimoma of papilla of Vater, pancreas-sparing

Reprint requests
Masanori Ishii Department of Surgery, Tokai University School of Medicine
Bouseidai, Isehara, 259-1193 JAPAN

Accepted
July 27, 2005

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