AMPULLECTOMIA E CARCINOMA GIGANTE DELLA PAPILLA DI VATER

The case of a giant carcinoma of Vater's papilla is reported. The clinical/diagnostic paths and therapeutic indications for ampullectomy are analysed on the basis of the good survival rate observed more than five years after transduodenal excision and in the light of the most recent literature. The authors believe that accurate, early diagnosis and histological typing is fundamental for an appropriate selection of patients when complex surgical decisions have to be taken. They consider ampullectomy to be a valid therapeutic option, certainly in the case of benign neoplasias, and duodenocephalopancreasectomy (DCP) to be the operation of choice for the treatment of ampullar and periampullar malignant neoplasias. The dimensions of the neoplasias cannot be considered an absolute parameter because it is always necessary to take the patient's general clinical condition into account. The difficulty of formulating correct statistical analyses on the basis of non-homogeneous series is pointed out and it is pointed out that five year survival is satisfactory. In selected cases, by reason of earlier and earlier diagnosis and in view of the poor clinical condition of certain patients and the high operative risk of DCP, there is room for transduodenal exeresis for malignant cancers too