2019 Volume 33 Issue 1 Pages 54-59
Pancreaticoduodenectomy is a standard treatment for ampullary carcinoma. Among biliary carcinoma, this tumor shows the highest R0 resection rate and favorable outcomes after resection. From results of pathological studies, when ampullary carcinoma is limited to mucosa of the ampulla of Vater and does not invade the sphincter of Oddi, the possibility of lymph node metastasis is extremely low, suggesting that local excision is theoretically indicated for such tumor. However, because current preoperative imaging cannot accurately make a diagnosis of invasion to the sphincter of Oddi, in principle, local excision should not be indicated for ampullary carcinoma. For ampullary adenoma, local excision could be applied, but detailed pathological examination is mandatory after resection. Pancreatic invasion is an important prognostic factor; if the tumor invades into the pancreas, perineural invasion is frequently observed and the tumor might have malignant biological potential similar to pancreatic carcinoma. Lymph node metastasis is a strong prognostic factor and the number of positive lymph nodes could better stratify patient outcomes after resection.
