乳頭部切除術を施行した高齢者十二指腸乳頭部癌の1例

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  • A CASE OF OLD-AGE AMPULLARY CARCINOMA TREATED BY LOCAL EXCISION

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We report a case of early ampullary carcinoma in an 81-year-old female surgically treated by local excision. Distal gastrectomy and diabetes melitus were revealed in her past history. Ampullary carcinoma was detected during treatment for acute cholecystitis complicated by liver abscess and formation of fistula between the gallbladder and jejunum. Local excion of ampulla Vater was done because it seemed too risky to perform pancreatoduodenectomy. The resected specimen was 1.7cm, polypoid-type tumor.<br>Histopathologically, it was diagnosed as well-differentiated tubular adenocarcinoma limited to the mucosa. The postoperative clinical course was good, and there has been no recurrence to date 16 months after the operation. Among the 25 cases of locally resected ampullary carcinoma reported in Japan, there were no recurrences or mortality in the 13 cases of early ampullary carcinoma (mean observation period: 17 months), in which the carcinoma remains within the sphincter of Oddi muscle. Among the 9 advanced cases, 6 patients died of the cancer (mean survival time: 25 months). Local resection of the ampulla should be considered the procedure of choice for the patients of ampullary adenoma or early ampullary carcinoma with severe concomitant disease.

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