摘要
PURPOSE: 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 can cer, less aggressive surgical procedure (such as ampullectomy) must be evaluated in selected patients with familial adenomatous polyposis patients presenting low-risk benign duodenal adenomas. METHODS: From 1995 to 2000, we performed a r etrospective, observational study, which included eight patients (5 females) wit h familial adenomatous polyposis underwent ampullectomy (with frozen sections) f or presumed benign polyposis lesions. Six patients had an ileal pouch-anal anas tomosis performed 2 to 27 years before ampullectomy. The remaining two patients had ampullectomy during the same operation than ileal pouch-anal anastomosis. R ESULTS: 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 t hat three patients had a severe dysplasia. Mean follow-up of the patients was 5 8 ±37 (range, 24-119) months. During endoscopic follow-up, although all the p atients underwent endoscopic resection of duodenal polyps, none presented recurr ence at the ampullectomy site. CONCLUSIONS: Ampullectomy could be safely propose d 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 patie nts with high-risk ampullary adenomas without invasive carcinoma.
PURPOSE: 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 can cer, less aggressive surgical procedure (such as ampullectomy) must be evaluated in selected patients with familial adenomatous polyposis patients presenting low-risk benign duodenal adenomas. METHODS: From 1995 to 2000, we performed a r etrospective, observational study, which included eight patients (5 females) wit h familial adenomatous polyposis underwent ampullectomy (with frozen sections) f or presumed benign polyposis lesions. Six patients had an ileal pouch-anal anas tomosis performed 2 to 27 years before ampullectomy. The remaining two patients had ampullectomy during the same operation than ileal pouch-anal anastomosis. R ESULTS: 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 t hat three patients had a severe dysplasia. Mean follow-up of the patients was 5 8 ±37 (range, 24-119) months. During endoscopic follow-up, although all the p atients underwent endoscopic resection of duodenal polyps, none presented recurr ence at the ampullectomy site. CONCLUSIONS: Ampullectomy could be safely propose d 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 patie nts with high-risk ampullary adenomas without invasive carcinoma.
