Abstract
A standard treatment for ampullary region carcinoma is pancreaticoduodenectomy with regional lymph node dissection, because some patients have lymph node metastasis once the carcinomas invade the sphincter of Oddi. Overall 5-year survival rate after pancreaticoduodenectomy exceeds 90% when it is ampullary region carcinoma of Stage 0-IB. Lymph node metastasis is the strongest prognostic factor, and, besides, pancreatic invasion, histological differentiation and lymphovascular infiltration are reported to be significant worse prognosic factors. Local resection such as transduodenal papillectomy is less invasive and safer than pancreaticoduodenectomy and, theoretically, this procedure could be indicaed for ampullary region carcinoma without invasion to the sphincter of Oddi. However, since accurate preoperative diagnosis of the invasion to the sphincter of Oddi is currently difficult, local resection should not be indicated for patients with preoperative proven carcinoma unless pancreaticoduodenectomy is not feasible. For benign ampullary region neoplasms, endoscopic or surgical papillectomy is performed, but intra- and post-operative detailed pathologic examinations are mandatory.
