Endoscopic papillectomy could be rewarding to patients with early stage duodenal ampullary carcinoma?

• Published in: Journal of hepato-biliary-pancreatic sciences Vol. 31; no. 3; pp. 203 - 212
• Main Authors: Suzuki, Ko, Kurita, Yusuke, Kubota, Kensuke, Fujita, Yuji, Tsujino, Seitaro, Koyama, Yuji, Tsujikawa, Shintaro, Tamura, Shigeki, Yagi, Shin, Hasegawa, Sho, Sato, Takamitsu, Hosono, Kunihiro, Kobayashi, Noritoshi, Iwashita, Hiromichi, Yamanaka, Shoji, Fujii, Satoshi, Endo, Itaru, Nakajima, Atsushi
• Format: Journal Article
• Language: English
• Published: Japan Wiley Subscription Services, Inc 01-03-2024
• Subjects: adenocarcinoma; Adenocarcinoma - pathology; Adenocarcinoma - surgery; Ampulla of Vater - pathology; Ampulla of Vater - surgery; ampullary carcinoma; ampullary tumor; Cancer; carcinoma in situ; Common Bile Duct Neoplasms - diagnostic imaging; Common Bile Duct Neoplasms - pathology; Common Bile Duct Neoplasms - surgery; endoscopic papillectomy; Endoscopy; Endoscopy, Gastrointestinal; Humans; Pancreatic Neoplasms - pathology; Retrospective Studies; Treatment Outcome; Tumors; ampullary tumor; adenocarcinoma; endoscopic papillectomy; carcinoma in situ; ampullary carcinoma
• ISSN: 1868-6974; 1868-6982
• DOI: 10.1002/jhbp.1398

Background/Purpose
There is currently no consensus on the use of endoscopic papillectomy (EP) for early stage duodenal ampullary adenocarcinoma. This study aimed to evaluate the feasibility of EP for patients with early stage duodenal ampullary adenocarcinoma.
Methods
Patients who underwent EP for ampullary adenocarcinomas were investigated. Complete and clinical complete resection rates were evaluated. Clinical complete resection was defined as either complete resection or resection with positive or unknown margins but no cancer in the surgically resected specimen, or no recurrence on endoscopy after at least a 1‐year follow‐up.
Results
Adenocarcinoma developed in 30 patients (carcinoma in situ [Tis]: 21, mucosal tumors [T1a(M)]: 4, tumors in the sphincter of Oddi [T1a(OD)]: 5). The complete resection rate was 60.0% (18/30) (Tis: 66.7% [14/21], T1a[M]: 50.0% [2/4], and T1a[OD]: 40.0% [2/5]). The mean follow‐up period was 46.8 months. The recurrence rate for all patients was 6.7% (2/30). The clinical complete resection rates of adenocarcinoma were 89.2% (25/28); rates for Tis, T1a(M), and T1a(OD) were 89.4% (17/19), 100% (4/4), and 80% (4/5), respectively.
Conclusions
EP may potentially achieve clinical complete resection of early stage (Tis and T1a) duodenal ampullary adenocarcinomas.
Suzuki and colleagues found that endoscopic papillectomy has the potential to achieve clinical complete resection of early‐stage duodenal ampullary carcinoma. Cases with positive or unknown margins may not necessarily require additional surgical resection, and follow‐up may be acceptable in selected populations, such as elderly patients or those at high surgical risk.