• Ampullary carcinoma
• Immunohistochemistry
• Long-term survival
• Lymph node ratio

• Cancer
• Carcinoma duodenal
• Cáncer
• Duodenal carcinoma
• Duodeno
• Duodenum
• Endoscopia
• Endoscopy

Ampullary neoplasms, although rare, present distinctive clinical and pathological features from other neoplastic lesions of the periampullary region. No specific guidelines about their management are available, and they are often assimilated either to biliary tract or to pancreatic carcinomas. Due to their location, they tend to become symptomatic at an earlier stage compared to pancreatic malignancies. This behaviour results in a higher resectability rate at diagnosis. From 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 type. This classification has a substantial impact on prognosis. In most cases, pancreaticoduodenectomy represents the treatment of choice when there is an overt or highly suspicious malignant behaviour. The rate of potentially curative resection is as high as 90% and in high-volume centres an acceptable rate of complications is reported. In 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 carcinomas. Importantly, these methods have the drawback of not including an appropriate lymphadenectomy, while nodal involvement has been shown to be frequently present also in apparently low-risk carcinomas. Endoscopic 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 ultrasound. In 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.

• Ampulla of Vater
• Cancer of the ampulla of Vater
• Pancreaticoduodenectomy
• Ampullectomy
• Prognosis
• Ampullary neoplasm
• Lymphadenectomy
• Recurrence

• Algorithms
• Ampulla of Vater/pathology
• Ampulla of Vater/surgery
• Common Bile Duct Diseases/epidemiology
• Common Bile Duct Diseases/mortality
• Common Bile Duct Diseases/pathology
• Common Bile Duct Diseases/surgery
• Critical Pathways
• Endoscopy, Digestive System/adverse effects
• Endoscopy, Digestive System/mortality
• Humans
• Lymph Node Excision
• Neoplasm Staging
• Pancreaticoduodenectomy/adverse effects
• Pancreaticoduodenectomy/mortality
• Predictive Value of Tests
• Risk Factors
• Treatment Outcome

We focus on the diagnostic and therapeutic problems of duodenal adenocarcinoma, reporting a case and reviewing the literature. A 65-year old man with adenocarcinoma in the third duodenal portion was successfully treated with a segmental resection of the third part of the duodenum, avoiding a duodeno-cephalo-pancreatectomy. This tumor is very rare and frequently affects the III and IV duodenal portion. A precocious diagnosis and the exact localization of this neoplasia are crucial factors in order to decide the surgical strategy. Given a non-specificity of symptoms, endoscopy with biopsy is the diagnostic gold standard. Duodeno-cephalo-pancreatectomy (DCP) and segmental resection of the duodenum (SRD) are the two surgical options, with overlapping morbidity (27% vs 18%) and post operative mortality (3% vs 1%). The average incidence of postoperative long-term survival is 100%, 73.3% and 31.6% of cases after 1, 3 and 5 years from surgery, respectively. Long-term survival is made worse by two factors: the presence of metastatic lymph nodes and tumor localization in the proximal duodenum. The two surgical options are radical: DCP should be used only for proximal localizations while SRD should be chosen for distal localizations.

• Duodenal carcinoma
• Duodeno-cephalo-pancreatectomy
• Segmental resection
• Survival
• III duodenal portion
• Duodenal embryological development