Management of ampullary neoplasms: A tailored approach between endoscopy and surgery

作     者：Francesca Panzeri Stefano Crippa Paola Castelli Francesca Aleotti Alessandro Pucci Stefano Partelli Giuseppe Zamboni Massimo Falconi 

作者机构：Department of SurgeryOspedale "Mater Salutis" Division of Pancreatic SurgerySan Raffaele Hospital IRCCSVita e Salute University Department of PathologyOspedale Sacro Cuore-Don Calabria 

出 版 物：《World Journal of Gastroenterology》 (世界胃肠病学杂志（英文版）)

年 卷 期：2015年第21卷第26期

页      面：7970-7987页

核心收录：

学科分类：1002[医学-临床医学] 100214[医学-肿瘤学] 10[医学] 

主　　题：Ampulla of Vater Cancer of the ampullaof Vater Pancreaticoduodenectomy Ampullectomy Prognosis Ampullary neoplasm Lymphadenectomy Recurrence 

摘      要：Ampullary neoplasms,although rare,present distinctive clinical and pathological features from other neoplastic lesions of the periampullary *** specific guidelines about their management are available,and they are often assimilated either to biliary tract or to pancreatic *** to their location,they tend to become symptomatic at an earlier stage compared to pancreatic *** behaviour results in a higher resectability rate at *** a pathological point of view they arise in a zone of transition between two different epithelia,and,according to their origin,may be divided into pancreatobiliary or intestinal *** classification has a substantial impact on *** most cases,pancreaticoduodenectomy represents the treatment of choice when there is an overt or highly suspicious malignant *** rate of potentially curative resection is as high as 90% and in high-volume centres an acceptable rate of complications is *** selected situations less invasive approaches,such as ampullectomy,have been advocated,although there are some concerns mainly because of a higher recurrence rate associated with limited resections for invasive ***,these methods have the drawback of not including an appropriate lymphadenectomy,while nodal involvement has been shown to be frequently present also in apparently lowrisk *** ampullectomy is now the procedure of choice in case of low up to high-grade dysplasia providing a proper assessment of the T status by endoscopic *** the present paper the evidence currently available is reviewed,with the aim of offering an updated framework for diagnosis and management of this specific type of disease.