Skip to main content
SpringerLink
Log in

Villous tumors of the duodenum: Reappraisal of local vs. extended resection

  • Published:
Journal of Gastrointestinal Surgery

Abstract

Benign villous tumors of the duodenum are often managed by transduodenal local excision. Risk of local recurrence, coupled with improving safety of radical pancreaticoduodenectomy, has prompted reexamination of the roles of conservative and radical operations. The aim of this study was to determine long-term outcome after local and extended resection in order to identify factors to consider in planning operative strategy. Eighty-six patients (mean age 64 years) with villous tumors of the duodenum managed surgically from 1980 to 1997 were reviewed. Histologic findings, size, presence of polyposis syndromes, and extent of resection were correlated with outcome. Villous tumors were benign adenomas in 64 patients (74%), contained carcinoma in situ in three (4%), and invasive carcinoma in 19 (22%). The presence of cancer was not known preoperatively in 9 (47%) of the 19 with invasive carcinoma. Operative treatment included transduodenal local excision in 53 patients, pancreaticoduodenectomy in 20, pancreas-sparing duodenectomy in five, full-thickness excision in four, and other in six. Among the 50 patients with benign tumors managed by local excision, 17 had a recurrence with actuarial rates of 32% at 5 years and 43% at 10 years; four of the recurrences (24%) were adenocarcinomas. The recurrence rate was influenced by the presence of a polyposis syndrome but not by tumor size. Recurrence of benign villous tumors after local excision is common and may be malignant. Pancreaticoduodenectomy is appropriate for villous tumors containing cancer and may be considered an alternative for select patients with benign villous tumors of the duodenum. If local excision is performed, regular postoperative endoscopic surveillance is mandatory.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Bjork KJ, Davis CJ, Nagorney DM, Mucha P. Duodenal vil- lous tumors. Arch Surg 1990;125:961–965.

    PubMed  CAS  Google Scholar 

  2. Chappuis CW, Divincenti FC, Cohn I. Vdlous tumors of the duodenum. Ann Surg 1989;209:593–599.

    Article  PubMed  CAS  Google Scholar 

  3. Asbun HJ, Rossi RL, Munson JL. Local resection for ampullary tumors: Is there a place for it? Arch Surg 1993;128:515–520.

    PubMed  CAS  Google Scholar 

  4. Zinzindohoue F, Gallot D, Majery N, Malafosse M. Pour un traitement radical des nappes villeuses du duodenum. Ann Chir 1996;50:330–332.

    PubMed  CAS  Google Scholar 

  5. Ryan DP, Shapiro RH, Warshaw AL. Villous tumors of the duodenum. Ann Surg 1986;203:301–306.

    Article  PubMed  CAS  Google Scholar 

  6. Komorowski RA, Cohen EB: Villous tumors of the duode- num: A clinicopathological study. Cancer 1981;47:1377–1386.

    Article  PubMed  CAS  Google Scholar 

  7. Penna C, Bataille N, Balladur P, Tiret E, Part R. Surgical treatment of severe duodenal polyposis in familial adenoma- tous polyposis. Br J Surg 1998;85:665–668.

    Article  PubMed  CAS  Google Scholar 

  8. Nugent KP, Spigelman AD, Williams CB. Surveillance of du- odenal polyps in familial adenomatous polyposis: Progress re- port. J R Sot Med 1994;87:704–706.

    CAS  Google Scholar 

  9. Bleau BL, Gostout CJ. Endoscopic treatment of ampullary adenomas in familial adenomatous polyposis. J Clin Gas-troenterol 1996;22:237–241.

    Article  CAS  Google Scholar 

  10. Galandiuk S, Hermann RE, Jagelman DG, Fazio VW, Sivak MV. Villous tumors of the duodenum. Ann Surg 1988;207:234–239.

    Article  PubMed  CAS  Google Scholar 

  11. Goldberg M, Zamir A, Nissan S. Wide local excision as an al- ternative treatment for periampullary carcinoma. Am J Gas- troenterol 1987;82:1169–1171.

    CAS  Google Scholar 

  12. Gray G, Browder W. Villous tumors of the ampulla of Vater: Local resection versus pancreaticoduodenectomy. South Med J 1989;82:917–920.

    PubMed  CAS  Google Scholar 

  13. Shemesh E, Nass S, Czerniak A. Endoscopic sphincterotomy and endoscopic fulguration in the management of adenoma of the papilla of Vater. Surg Gynecol Obstet 1989;169:445–448.

    PubMed  CAS  Google Scholar 

  14. Sakorafas GH, Sarr MG. Local excision of villous tumours of the duodenum. Eur J Surg Oncol 1999;25:90–93.

    Article  PubMed  CAS  Google Scholar 

  15. Rattner DW, Femandez de-Castillo C, Brugge WR, Warshaw AL. Defining the criteria for local resection of ampullary neo- plasm. Arch Surg 1996;131:366–371.

    PubMed  CAS  Google Scholar 

  16. Shapiro TM. Adenocarcinoma of the pancreas: A statistical analysis of bypass vs Whipple resection in good risk patients. Ann Surg 1975;182:715–721.

    Article  PubMed  CAS  Google Scholar 

  17. Crile G. The advantages of bypass operation over radical pan- creatoduodenectomy in the treatment of pancreatic carci- noma. Surg Gynecol Obstet 1970;130:1049–1053.

    PubMed  Google Scholar 

  18. Hertzberg J. Pancreatico-duodenal resection and by-pass op- eration in patients with carcinoma of the head of the pancreas, ampulla, and distal end of the common bile duct. Acta Chir Stand 1974;140:523–527.

    CAS  Google Scholar 

  19. Strasberg SM, Drebin JA, Soper NJ. Evolution and current status of the Whipple procedure: An update for gastroen- terologists. Gastroenterology 1997;113:983–994.

    Article  PubMed  CAS  Google Scholar 

  20. Cameron JL, Pitt HA, Yeo CJ, Lillemoe KD, Kaufman HS, Coleman J. One hundred and forty-five consecutive pancreato- duodenectomies without mortality. Ann Surg 1993;217:430–438.

    Article  PubMed  CAS  Google Scholar 

  21. Trede M, Schwall G, Saeger HD. Survival after pancreatodu- odenectomy. 118 consecutive resections without an operative mortality. Ann Surg 1990;210:447–458.

    Article  Google Scholar 

  22. Femandez del Castillo C, Ratmer DW, Warshaw AL. Standards for pancreatic resection in the 1990s. Arch Surg 1995;130:295–300.

    Google Scholar 

  23. Gordon TA, Burleyson GP, Tielsch JM, Cameron JL. The ef- fects of regionalization on cost and outcome for one general high-risk surgical procedure. Ann Surg 1995;221:43–49.

    Article  PubMed  CAS  Google Scholar 

  24. Crist DW, Stizmann JV, Cameron JL. Improved hospital mor- bidity, mortality and survival after the Whipple procedure. Ann Surg 1987;206:358–365.

    Article  PubMed  CAS  Google Scholar 

  25. Pellegrini CA, Heck CF, Raper S, Way LW. An analysis of the reduced morbidity and mortality rates after pancreaticoduo- denectomy. Arch Surg 1989;124:778–781.

    PubMed  CAS  Google Scholar 

  26. McLeod RS, Taylor BR, O’Connor BI, Greenberg GR, Jee-jeebhoy KN, Royal1 D, Langer B. Quality of life, nutritional status, and gastrointestinal hormone profile following the Whipple procedure. Am J Surg 1995;169:179–185.

    Article  PubMed  CAS  Google Scholar 

  27. Monson JRT, Donohue JH, McEntee GP, McIlmth DC, van Heerden JA, Shorter RG, Nagorney DM, Ilstrup DM. Radi- cal resection for carcinoma of the ampulla of Vater. Arch Surg 1991;126:353–357.

    PubMed  CAS  Google Scholar 

  28. Offerhaus GJA, Giardiello FM, Krush AJ, Booker SV, Tersmette AC, Kelley NC, Hamilton SR. The risk of upper gastrointestinal cancer in familial adenomatous polyposis. Gastroenterology 1992;102:1980–1982.

    PubMed  CAS  Google Scholar 

  29. Jagelman DG, DeCosseJJ, Bussey HJR. Upper gastrointesti- nal cancer in familial adenomatous polyposis. Lancet 1988;l:1149–1151.

    Article  Google Scholar 

  30. Arvanitis ML, Jagelman DG, Fazio VW, Lavery IC, McGannon E. Mortality in patients with familial adenomatous polyposis. Dis Colon Rectum 1990;33:639–642.

    Article  PubMed  CAS  Google Scholar 

  31. Goedde TA, Rodriguez-Bigas MA, Herrera L, Petrelli NJ. Gastroduodenal polyps in familial adenomatous polyposis. Surg Oncol 1992;1:357–361.

    Article  PubMed  CAS  Google Scholar 

  32. Belchetz LA, Berk T, Bapat BV, Cohen Z, Gallinger S. Changing causes of mortality in patients with familial adeno- matous polyposis. Dis Colon Rectum 1996;39:384–387.

    Article  PubMed  CAS  Google Scholar 

  33. Presciuttini S, Sala P, Roddetti C, Petrouisti M. The Italian registry of familial polyposis. Causes of death and post-surgi- cal survival in familial adenomatous polyposis: Results from the Italian registry. Semin Surg Oncol 1994;10:225–234.

    Article  PubMed  Google Scholar 

  34. Iwama T, Mishima Y, Utsunomiya J. The impact of familial adenomatous polyposis on the tumorigenesis and mortality at the several organs. Ann Surg 1993;217:101–108.

    Article  PubMed  CAS  Google Scholar 

  35. Iwama T, Tomita H, Kawachi Y, et al.. Indications for local excision of ampullary lesions associated with familial adeno- matous polyposis. J Am Co11 Surg 1994;179:462–464.

    CAS  Google Scholar 

  36. Sanabria JR, Croxford R, Berk TC, Cohen Z, Bapat BV, Gallinger S. Familial segregation in the occurrence and sever- ity of periampullary neoplasms in familial adenomatous poly- posis. AmJ Surg 1996;171:136–141.

    Article  CAS  Google Scholar 

  37. Wallace MH, Phillips RKS. Upper gastrointestinal disease in patients with familial adenomatous polyposis. Br J Surg 1998; 85:742–750.

    Article  PubMed  CAS  Google Scholar 

  38. Chung RS, Church JM, van Stokl R. Pancreas-sparing duode- nectomy: Indications, surgical technique, and results. Surgery 1995;117:254–259.

    Article  PubMed  CAS  Google Scholar 

  39. Maher MM, Yeo CJ, Lillemoe KD, Roberts JR, Cameron JL. Pancreas-sparing duodenectomy for infra-ampullary duode- nal pathology. AmJ Surg 1996;171:62–67.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Deparmaent of Surgery, Mayo Clinic and Mayo Foundation, Rochester, Minn.

    Michael B. Farnell M.D. (Professor of Surgery), George H. Sakorafas M.D., Michael G. Saq M.D., David R. Farley M.D. & David M. Nagorney M.D.

  2. Section of Biostatistics, Mayo Clinic and Mayo Foundation, Rochester, Minn.

    Charles M. Rowland M.S.

  3. Truman Medical Center, Kansas City, Mo

    Gregory G. Tsiotos M.D.

Authors
  1. Michael B. Farnell M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. George H. Sakorafas M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Michael G. Saq M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Charles M. Rowland M.S.
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Gregory G. Tsiotos M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. David R. Farley M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. David M. Nagorney M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Farnell, M.B., Sakorafas, G.H., Saq, M.G. et al. Villous tumors of the duodenum: Reappraisal of local vs. extended resection. J Gastrointest Surg 4, 13–23 (2000). https://doi.org/10.1016/S1091-255X(00)80028-1

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1016/S1091-255X(00)80028-1

Key words

Search

Navigation