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Management of Villous Adenoma of the Ampulla of Vater

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Difficult Decisions in Hepatobiliary and Pancreatic Surgery

Part of the book series: Difficult Decisions in Surgery: An Evidence-Based Approach ((DDSURGERY))

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Abstract

Adenomas are the most common benign tumor of the ampulla of Vater and are thought to follow a similar adenoma-carcinoma sequence as seen in colonic adenocarcinomas. This is particularly the case for the villous subtype. Because of this potential for malignant degeneration, when identified, ampullary adenomas should be considered for resection. There is controversy however, on how to best treat these lesions with options including endoscopic or open ampullectomy or pancreaticoduodenectomy. Although there is increased morbidity and mortality with a pancreaticoduodenectomy procedure, the rates of incomplete resection and recurrence are higher with endoscopic and open ampullectomy. Lesion characteristics that support a full oncologic resection with a pancreaticoduodenectomy as opposed to the other procedures include ones that are >3 cm in size; firm, ulcerated, or friable; with intraductal extension; and with evidence of high-grade dysplasia, carcinoma in situ, or invasion.

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Authors and Affiliations

  1. Department of Surgical Oncology, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA, 19111, USA

    Ashley N. Hardy

  2. Department of Surgery, Northwestern University Feinberg School of Medicine, 676 Saint Clair St, Arkes Pavilion, Suite 6-650, Chicago, IL, 60611, USA

    David J. Bentrem & Jeffrey D. Wayne

Authors
  1. Ashley N. Hardy
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  2. David J. Bentrem
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  3. Jeffrey D. Wayne
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Correspondence to Ashley N. Hardy .

Editor information

Editors and Affiliations

  1. The University of Chicago, CHICAGO, Illinois, USA

    J. Michael Millis

  2. The University of Chicago, CHICAGO, Illinois, USA

    Jeffrey B. Matthews

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Hardy, A.N., Bentrem, D.J., Wayne, J.D. (2016). Management of Villous Adenoma of the Ampulla of Vater. In: Millis, J., Matthews, J. (eds) Difficult Decisions in Hepatobiliary and Pancreatic Surgery. Difficult Decisions in Surgery: An Evidence-Based Approach. Springer, Cham. https://doi.org/10.1007/978-3-319-27365-5_54

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  • DOI: https://doi.org/10.1007/978-3-319-27365-5_54

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-27363-1

  • Online ISBN: 978-3-319-27365-5

  • eBook Packages: MedicineMedicine (R0)

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