Abstract
Ampullary carcinoid tumors are extremely rare. The present study describes the clinicopathological features and outcomes for 10 ampullary carcinoid patients who underwent radical resection from 1998 to 2005. During this study period, 294 patients underwent pancreatoduodenectomy for ampullary neoplasms in our institution. The mean patient age was 58.0 ± 13.4 years, and seven were male. Initial clinical manifestations were jaundice in four patients, nonspecific gastrointestinal symptoms in five, and completely asymptomatic in one. Standard pancreatoduodenectomy was performed in three patients, and pylorus-preserving pancreatoduodenectomy in seven, and there were no major complications. The mean tumor size and volume were 2.1 ± 1.3 cm and 4.1 ± 6.9 ml, respectively. Synaptophysin staining was positive in ten patients and chromogranin staining positive in eight. R0 resection was achieved in all ten patients. Overall and disease-free survival rates were 90 and 80% at 1 year, and 64 and 56% at 3 years, respectively. The liver was the most common site of initial metastasis after curative resection. Univariate analyses revealed that a maximal tumor diameter ≥2 cm and tumor extension beyond the ampulla were risk factors for tumor recurrence. In conclusion, while the majority of ampullary carcinoids are indolent, this tumor is associated with a relatively poor prognosis. We believe that radical resection, with the aim of complete tumor removal and cure, is the treatment of choice.
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References
Warren WK, McDonald MW, Humelogan JC. Periampullary and duodenal carcinoid tumors. Gut. 1964;5:448–449.
Walton GF, Gibbs ER, Spencer GO, Laws HL. Carcinoid tumors of the ampulla of Vater. Am Surg. 1997;63:302–304.
Clements WM, Martin SP, Stemmerman G, Lowy AM. Ampullary carcinoid tumors: rationale for an aggressive surgical approach. J Gastrointest Surg. 2003;7:773–776.
Hatzitheoklitos E, Buchler MW, Friess H, Poch B, Ebert M, Mohr W, et al. Carcinoid of the ampulla of Vater. Clinical characteristics and morphologic features. Cancer. 1994;73:1580–1588.
Makhlouf HR, Burke AP, Sobin LH. Carcinoid tumors of the ampulla of Vater: a comparison with duodenal carcinoid tumors. Cancer. 1999;85:1241–1249.
Poultsides GA, Frederick WA. Carcinoid of the ampulla of Vater: morphologic features and clinical implications. World J Gastroenterol. 2006;12:7058–7060.
Hwang S, Moon KM, Park JI, Kim MH, Lee SG. Retroduodenal resection of ampullary carcinoid tumor in a patient with cavernous transformation of the portal vein. J Gastrointest Surg. 2007; 11:1322–1327.
Gilani N, Ramirez FC. Endoscopic resection of an ampullary carcinoid presenting with upper gastrointestinal bleeding: a case report and review of the literature. World J Gastroenterol. 2007;13:1268–1270.
Mayoral W, Salcedo J, Al-Kawas F. Ampullary carcinoid tumor presenting as acute pancreatitis in a patient with von Recklinghausen’s disease: case report and review of the literature. Endoscopy. 2003;35:854–857.
Akerstrom G. Management of carcinoid tumors of the stomach, duodenum, and pancreas. World J Surg. 1996;20:173–182.
Yano F, Hama Y, Abe K, Iwasaki Y, Hatsuse K, Kusano S. Carcinoid tumor of the ampulla of Vater. Magnetic resonance imaging findings. Clin Imaging. 2005;29:207–210.
Gordon TA, Bowman HM, Tielsch JM, Bass EB, Burleyson GP, Cameron JL. Statewide regionalization of pancreaticoduodenectomy and its effect on in-hospital mortality. Ann Surg. 1998;228:71–78.
Oberg K. Carcinoid tumors: molecular genetics, tumor biology, and update of diagnosis and treatment. Curr Opin Oncol. 2002;14:38–45.
Bornstein-Quevedo L, Gamboa-Domínguez A. Carcinoid tumors of the duodenum and ampulla of Vater: a clinicomorphologic, immunohistochemical, and cell kinetic comparison. Hum Pathol. 2001;32:1252–1256.
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Hwang, S., Lee, SG., Lee, YJ. et al. Radical Surgical Resection for Carcinoid Tumors of the Ampulla. J Gastrointest Surg 12, 713–717 (2008). https://doi.org/10.1007/s11605-007-0389-3
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DOI: https://doi.org/10.1007/s11605-007-0389-3