Carcinoid of the ampulla of Vater. Local resection or pancreaticoduodenectomy.

BACKGROUND

Carcinoid of the ampulla of Vater is a rare lesion that may produce obstructive jaundice. Analysis of nodal involvement as a function of primary tumor sizes indicated that metastases occur with tumors smaller than 2.0 cm. The case of a 36-year-old woman is presented and the literature reviewed in an attempt to define the treatment of choice.

METHODS

The English literature was reviewed, and 27 cases including the current one were identified. All cases were traced to the original case report. Clinical outcome data were tabulated.

RESULTS

The mean age of the sample group was 48.5 years, with 52% men and 48% women. Jaundice occurred in 60% of patients. Ampullary carcinoid developed in nine patients in association with von Recklinghausen disease. Treatment included pancreaticoduodenectomy, local excision, and biliary-enteric and endoscopic stenting. Seven patients had positive nodes. Four had metastatic disease at the time of surgical treatment. Long-term survivals of 5.5 years and 5 years were achieved after local excision and pancreaticoduodenectomy, respectively.

CONCLUSIONS

Long-term survival is possible after local excision or pancreaticoduodenectomy.