Management of ampullary region tumor

Abstract

According to the biliary tract cancer registry, accurate diagnosis and surgery with definite lymph node dissection are necessary for improving the treatment outcomes of ampullary region carcinoma. EUS and IDUS are useful for the diagnosis of ampullary carcinoma, and the management is decided according to the result. In the biliary tract cancer clinical guidelines, when recognizing a tumor, pancreaticoduodenectomy is recommended. However, if the tumor does not invade Oddi's muscle layer (T1a), the possibility of lymph node metastasis is extremely low, and the application of papilla resection is also examined. When pancreaticoduodenectomy is performed, it is possible to perform safe surgery that suppresses the amount of bleeding by ligating the IPDA prior to pancreatectomy, and to ensure the dissection of No. 14 lymph node. Laparoscopic pancreaticoduodenectomy can be performed only in cases where lymph node dissection is unnecessary and strict case selection is necessary for the current indication. Robot-assisted laparoscopic pancreatoduodenectomy is effective for delicate procedures such as pancreaticojejunostomy, and hopefully insurance will be covered in the future.