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Surgical Ampullectomy with Complete Resection of the Common Bile Duct: a New Procedure for Radical Resection of Non-invasive Ampulloma with Biliary Extension

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Journal of Gastrointestinal Surgery

Abstract

Extension of ampulloma into the lower common bile duct (CBD) is observed in up to 30% of cases. This biliary extension can prevent complete tumor resection thus is considered as a contraindication for endoscopic and even surgical ampullectomy. For ampullomas associated with a prolonged biliary extension, a pancreaticoduodenectomy is associated with a high morbidity and can be considered as an overtreatment for a benign neoplasm. The present study describes a new surgical approach including ampullectomy with complete resection of the intrapancreatic CBD and restoration of both biliary and pancreatic flow by two separate anastomoses. This procedure was performed in seven patients for a non-invasive ampulloma with a 25- to 70-mm CBD involvement. No patients died and three developed postoperative complications. Resection was R0 in all patients but one. With a 24-month median follow-up (range = 3–84), no patients developed pancreatic insufficiency or tumor recurrence.

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Author Contribution

Alain Sauvanet: conception of the work; acquisition, analysis, and interpretation of data; drafting the work; final approval of the version to be published; and agreement to be accountable for all aspects of the work.

Safi Dokmak: acquisition and interpretation of data; revising the work critically for important intellectual content; final approval of the version to be published; and agreement to be accountable for all aspects of the work.

Jérome Cros: acquisition and interpretation of data; revising the work critically for important intellectual content; final approval of the version to be published; and agreement to be accountable for all aspects of the work.

Dominique Cazals-Hatem: acquisition and interpretation of data; revising the work critically for important intellectual content; final approval of the version to be published; and agreement to be accountable for all aspects of the work.

Philippe Ponsot: conception or design of the work; revising the work critically for important intellectual content; final approval of the version to be published; and agreement to be accountable for all aspects of the work.

Maxime Palazzo: acquisition and interpretation of data; revising the work critically for important intellectual content; final approval of the version to be published; and agreement to be accountable for all aspects of the work.

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Authors and Affiliations

  1. Department of Hepatic and Pancreatic Surgery, Pôle des Maladies de l’Appareil Digestif (PMAD) Hospital Beaujon, AP-HP, University Paris Diderot, 100 Boulevard du Général Leclerc, 92110, Clichy, France

    Alain Sauvanet & Safi Dokmak

  2. Department of Pathology, Hospital Beaujon, AP-HP, University Paris Diderot, 92110, Clichy, France

    Jérôme Cros & Dominique Cazals-Hatem

  3. Department of Endoscopy, Pôle des Maladies de l’Appareil Digestif (PMAD) Hospital Beaujon, AP-HP, University Paris Diderot, 92110, Clichy, France

    Philippe Ponsot & Maxime Palazzo

Authors
  1. Alain Sauvanet
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  2. Safi Dokmak
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  3. Jérôme Cros
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  4. Dominique Cazals-Hatem
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  5. Philippe Ponsot
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  6. Maxime Palazzo
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Correspondence to Alain Sauvanet.

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All six authors have no financial disclosure or conflict of interest in relation to this work.

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Sauvanet, A., Dokmak, S., Cros, J. et al. Surgical Ampullectomy with Complete Resection of the Common Bile Duct: a New Procedure for Radical Resection of Non-invasive Ampulloma with Biliary Extension. J Gastrointest Surg 21, 1533–1539 (2017). https://doi.org/10.1007/s11605-017-3457-3

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  • DOI: https://doi.org/10.1007/s11605-017-3457-3

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