Papilla of Vater Tumor: Diagnostic and therapeutic aspects and challenges in clinical-surgical management
DOI:
https://doi.org/10.33448/rsd-v14i10.49622Keywords:
Papilla of Vater Tumor, Ampulloma, Endoscopy, Pancreaticoduodenectomy, Clinical-Surgical Management.Abstract
Tumors of the papilla of Vater, also called ampullomas, represent a rare neoplasm of the digestive tract, but of great clinical importance due to the potential for biliary obstruction and malignant progression. Early diagnosis remains a challenge, given the nonspecific initial symptoms. This article aims to review the main diagnostic and therapeutic aspects, as well as the challenges in the clinical and surgical management of papilla of Vater tumors, offering an updated perspective that will help improve medical practice and develop more effective therapeutic strategies. A narrative literature search was conducted in PubMed, Scielo, and Embase, considering articles published in the last 10 years, as well as classic works on the subject. Publications in English, Spanish, and Portuguese that addressed diagnosis, treatment, and prognosis were included. Diagnosis involves a combination of imaging tests and endoscopic methods, with emphasis on endoscopic ultrasound and endoscopic retrograde cholangiopancreatography (ERCP). The standard treatment for resectable cases is pancreaticoduodenectomy (Whipple procedure), although endoscopic ampullectomy is an option for selected early tumors. Tumor recurrence, surgical complications, and appropriate patient selection still pose challenges. The role of adjuvant therapies remains under investigation, especially in the context of advanced or unresectable tumors. The management of papilla of Vater tumors requires a multidisciplinary approach, combining accurate diagnosis and individualized treatment. Advances in endoscopic and surgical techniques and complementary therapies offer promising prospects, but more robust studies are still needed to standardize approaches.
References
Albores-Saavedra, J., Schwartz, A. M., Batich, K. & Henson, D. E. (2009). Cancers of the ampulla of Vater: demographics, morphology, and survival based on 5,625 cases from the SEER program. Journal of Surgical Oncology. 100(7), 598-605.
Artinyan, A., Ji, L. & Bergamini, R. et al. (2011). Adjuvant therapy in periampullary cancers: a review. Journal of Gastrointestinal Surgery. 15(6), 1104-13.
Cameron, J. L., Roland, P. S. & Russell, R. C. (2006). Clinical presentation and laboratory findings in ampullary tumors. Annals of Surgery. 243(2), 180-7.
Edge, S. B. & Compton, C. C. (2010). The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Annals of Surgical Oncology. 17(6), 1471-4.
Howe, J. R., Klimstra, D. S. & Cordon-Cardo, C. et al. (1998). Adenomas of the ampulla of Vater: a clinicopathologic study including immunohistochemistry and K-ras mutation analysis. American Journal of Surgical Pathology. 22(5), 610-8.
Hori, T., Yamaguchi, K. & Kawamura, T. et al. (2016). Endoscopic ultrasound for staging ampullary tumors: clinical utility and limitations. Digestive Endoscopy. 28(1), 45-53.
Kahaleh, M., Sharma, V. K. & Levine, S. et al. (2015). Endoscopic management of ampullary lesions: indications and outcomes. Gastrointestinal Endoscopy. 82(4), 707-15.
Kim, J. H., Kim, Y. J. & Kim, M. J. et al. (2020). Anatomical variations of the pancreatic duct and their clinical relevance. Korean Journal of Radiology. 21(1), 10-24.
Kimura, W., Futakawa, N., Yamagata, S. et al. (1994). Different clinicopathologic findings in two histologic types of carcinoma of papilla of Vater. Japanese Journal of Cancer Research. 85(2), 161-6.
Kozarek, R. A., Carr-Locke, D., Ashok, R. et al. (2006). Endoscopic biliary stenting in malignant obstruction: clinical outcomes. Gastrointestinal Endoscopy. 63(5), 750-8.
Mao, C. Liu, Y., Li, X. et al. (2017). Molecular characterization and potential therapeutic targets of ampullary carcinoma. Oncotarget. 8(29), 48400-14.
Neoptolemos, J. P., Moore, M. J. & Cooper, M. et al. (2010). Adjuvant chemotherapy for ampullary carcinoma: current evidence and future directions. Annals of Surgery. 251(1), 56-65.
Paspatis, G. A., Dimitropoulos, S. I. & Doukas, P. et al. (2014). Endoscopic papillectomy for ampullary neoplasms: long-term outcomes and follow-up strategies. Endoscopy. 46(3), 227-34.
Pereira A. S. et al. (2018). Metodologia da pesquisa científica. [e-book gratuito]. Santa Maria/RS. Ed. UAB/NTE/UFSM. 9).
Rother, E. T. (2007). Revisão sistemática x revisão narrativa. Acta Paulista de Enfermagem. 20(2): 5-6.
Schueneman, A. & Goggins, M. (2021). Ampullary carcinoma: update on diagnosis, classification, treatment, and outcomes. World Journal of Gastrointestinal Oncology. 13(3), 265-80.
Scarpa, A., Capelli, P. & Zamboni, G. et al. (1996). Neoplasia of the ampulla of Vater. Pathology, clinical features, and molecular genetics. Annals of Oncology. 7(2), 129-36.
Sonh, T. A., Kaufman, H. & Fleming, J. et al. (1998). Clinical features and outcomes of patients with ampullary carcinoma. Annals of Surgery. 227(3), 380-9.
Testini, M., Gurrado, A. & Lissidini, G. et al. (2014). Management of ampullary neoplasms: a review. World Journal of Gastroenterology. 20(45), 15345-52.
Westgaard, A., Tafjord, S. & Farstad, I. N. et al. (2008). Pancreatobiliary versus intestinal histologic type of differentiation is an independent prognostic factor in resected periampullary adenocarcinoma. BMC Cancer. 8, 170.
Winter, J. M., Cameron, J. L. & Campbell, K. A. et al. (2006). 1423 pancreaticoduodenectomies for pancreatic cancer: a single-institution experience. Journal of Gastrointestinal Surgery. 10(9), 1199-210.
Yeo, C. J., Coleman, J. & Dulan, R. et al. (1997). Pancreaticoduodenectomy for ampullary carcinoma: operative results and long-term survival. Annals of Surgery. 225(6), 555-67.
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Copyright (c) 2025 Maria de Lourdes Rodrigues Ribeiro Silva, Wallace Peyroton do Couto, Vaneza Corrêa de Souza, Paula Cristina Cardoso Eccard, Ana Gentilia Batista de Bortolli, Felipe Magalhães Castro, Norton Martins de Barros, Arthur Santos Marquezini, Sandra Regina de Sá, Tatiana Regina Amaral
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