Long-term outcome after ampullectomy for ampullary lesions associated with familial adenomatous polyposis

• Published in: Diseases of the colon & rectum Vol. 48; no. 12; pp. 2192 - 2196
• Main Authors: OUAÏSSI, Mehdi, PANIS, Yves, SIELEZNEFF, Igor, ALVES, Amaud, PIRRO, Nicolas, ROBITAIL, Stéphane, HEYRIES, Laurent, VALLEUR, Patrice, SASTRE, Bernard
• Format: Journal Article
• Language: English
• Published: Secaucus, NJ Springer 01.12.2005; Lippincott Williams & Wilkins Ovid Technologies
• Subjects: Adenoma - prevention & control; Adenomatous Polyposis Coli - surgery; Adult; Aged; Ampulla of Vater - surgery; Anal Canal - surgery; Anastomosis, Surgical; Biological and medical sciences; Colonic Neoplasms - prevention & control; Digestive System Surgical Procedures - adverse effects; Digestive System Surgical Procedures - methods; Female; Follow-Up Studies; Gastroenterology. Liver. Pancreas. Abdomen; Humans; Ileum - surgery; Male; Medical sciences; Middle Aged; Morbidity; Pancreatic Neoplasms - prevention & control; Pancreaticoduodenectomy; Retrospective Studies; Risk Factors; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Tumors; Ampullary adenoma; Prognosis; Familial adenomatous polyposis; Adenoma; Familial adenomatous polyposis coli; Vater ampulla; Long term; Genetic disease; Ampullectomy; Gastroenterology; Digestive diseases; Intestinal disease; Benign neoplasm; Lesion
• ISSN: 0012-3706; 1530-0358
• DOI: 10.1007/s10350-005-0187-5

Up to 90 percent of patients with familial adenomatous polyposis develop adenomas in the upper gastrointestinal tract. Besides pancreaticoduodenectomy, which remains indicated in duodenal and ampullary cancer, less aggressive surgical procedure (such as ampullectomy) must be evaluated in selected patients with familial adenomatous polyposis patients presenting low-risk benign duodenal adenomas. From 1995 to 2000, we performed a retrospective, observational study, which included eight patients (5 females) with familial adenomatous polyposis underwent ampullectomy (with frozen sections) for presumed benign polyposis lesions. Six patients had an ileal pouch-anal anastomosis performed 2 to 27 years before ampullectomy. The remaining two patients had ampullectomy during the same operation than ileal pouch-anal anastomosis. No patient died postoperatively. Mean hospital stay was 15 +/- 6.5 (range, 10-21) days. There was one major complication (pancreatic fistula), which was treated conservatively. Final pathologic examination of the specimens revealed that three patients had a severe dysplasia. Mean follow-up of the patients was 58 +/- 37 (range, 24-119) months. During endoscopic follow-up, although all the patients underwent endoscopic resection of duodenal polyps, none presented recurrence at the ampullectomy site. Ampullectomy could be safely proposed in selected familial adenomatous polyposis patients. Our low morbidity and the absence of recurrence after almost five years of follow-up suggests that such conservative treatment could be proposed before pancreaticoduodenectomy in patients with high-risk ampullary adenomas without invasive carcinoma.