[Malignant tumors of the ampulla of Vater treated by cephalic duodenopancreatectomy. Apropos of 20 case reports].

Between 1966 and 1986, 27 tumors of the ampulla of Vater were operated on and 20 patients underwent potentially curative pancreatico-duodenal resection (PDR) (74% of resecability). The retrospective study of those 20 cases (13 men, 7 women, mean age: 59.9 +/- 9.8 years old) was done to evaluate the risks and the results of this type of wide resection. 15 patients (75%) had jaundice and gallbladder was palpable among 20 p. cent (4 cases) of the patients without cholecystectomy. Endoscopy was performed in 13 cases; endoscopic biopsies, done in 12 cases, were positive in 5 cases (45.4%), uncertain in three (25%) and falsely negative in four (33.3%). All the patients underwent Child's procedure. Histological analysis pointed out 15 adenocarcinomas and 5 malignant villous tumors; lymph node involvement was present in 11.1 p. cent; the staging following Martin's classification listed 6 stage 1, 3 stage II, 10 stage III and 1 stage IV. Operative mortality was of 5 p. cent; one patient died after an emergency procedure performed for massive bleeding but no death was observed in the group of patients treated out of emergency. Post-operative complications occurred in 5 patients (26.3%); none of the patient had pancreatico-jejunal or hepatico-jejunal anastomotic leakage. Hospitalisation had a mean duration of 22.8 +/- 6.4 days. The age over 65 years old, preoperative jaundice and preoperative endoscopic or surgical biliary drainage done to improve jaundice had no statistical influence upon post-operative morbidity. The 5 years survival rate following Kaplan Meier's method reached 44.5 p. cent.(ABSTRACT TRUNCATED AT 250 WORDS)