Evaluation of Resection of the Papilla of Vater for the Treatment of Cancer in the Papilla of Vater

• Published in: Kurume medical journal Vol. 50; no. 1-2; pp. 17 - 19
• Main Authors: KINOSHITA, HISAFUMI, HARA, MASAO, NISHIMURA, KAZUNORI, KODAMA, TAKAHITO, MATSUO, HIDEKI, KAWAHARA, RYUICHI, YASUNAGA, MASAFUMI, SAKAI, HISAMUNE, ODO, MASAHARU, OKUDA, KOJI, SHIROUZU, KAZUO, AOYAGI, SHIGEAKI
• Format: Journal Article
• Language: English
• Published: Japan Kurume University School of Medicine 2003
• Subjects: Aged; Aged, 80 and over; Ampulla of Vater - pathology; Ampulla of Vater - surgery; cancer in the papilla of Vater; Female; Humans; Male; Middle Aged; Pancreatic Neoplasms - surgery; quality of life; resection of the papilla of Vater; surgical treatment
• ISSN: 0023-5679; 1881-2090
• DOI: 10.2739/kurumemedj.50.17

We evaluated the resection of the papilla of Vater performed in patients with cancer in the papilla of Vater. The subjects were 6 patients who underwent resection of the papilla of Vater between January 1969 and December 2001. The patients aged 57-87 years consisted of 3 males and 3 females. The maximal diameter of the tumors was 0.5 cm in 1 patient, 1.5 cm in 3 patients, and 2.0 cm in 2 patients. Macroscopically, the tumors were of the protruded type (exposed) in 3 patients, of the mixed type (predominant protruded type) in 2 patients, and of the ulcerative type in 1 patient. The histological depth of the tumors was up to the mucosa in 1 patient, up to the oddi in 1 patient, up to the panc0, du1 in 1 patient, up to the panc1, du2 in 1 patient, and unknown in 2 patients. Histologically, the tumors were papillotubular adenocarcinoma (pap-tub) in 4 patients and tubular adenocarcinoma of the well-differentiated type (tubs) in 2 patients. Resection of the papilla of Vater was chosen because of high risk factors such as advanced age in 2 patients, complicated severe cirrhosis and confinement to bed due to poor systemic conditions after intracerebral hemorrhage in 3 patients, and hepatic metastasis observed during surgery in 1 patient. Residual cancer cells around the excised region were positive in 4 patients and unknown in the remaining 2 patients. Of the 6 patients, 5 died within 2 years after surgery, but 1 is alive without symptoms of recurrence 7 years after surgery. The death causes were the primary disease in 3 of the 5 patients. From the viewpoint of radical treatment, resection of the papilla of Vater cannot be chosen as a reduced surgery for cancer in the papilla of Vater. However, resection of the papilla of Vater can be applied to very elderly patients and patients under poor systemic conditions, for whom pancreatoduodenectomy (PD) is considered excessively invasive due to a small diameter of tumor.