Endoscopic and Surgical Management of Non-Metastatic Ampullary Neuroendocrine Neoplasia : A Multi-Institutional Pancreas2000/EPC Study
(2023) In Neuroendocrinology 113(10). p.1024-1034- Abstract
Introduction: Ampullary neuroendocrine neoplasia (NEN) is rare and evidence regarding their management is scarce. This study aimed to describe clinicopathological features, management, and prognosis of ampullary NEN according to their endoscopic or surgical management. Methods: From a multi-institutional international database, patients treated with either endoscopic papillectomy (EP), transduodenal surgical ampullectomy (TSA), or pancreaticoduodenectomy (PD) for ampullary NEN were included. Clinical features, post-procedure complications, and recurrences were assessed. Results: 65 patients were included, 20 (30.8%) treated with EP, 19 (29.2%) with TSA, and 26 (40%) with PD. Patients were mostly asymptomatic (n = 46; 70.8%). Median... (More)
Introduction: Ampullary neuroendocrine neoplasia (NEN) is rare and evidence regarding their management is scarce. This study aimed to describe clinicopathological features, management, and prognosis of ampullary NEN according to their endoscopic or surgical management. Methods: From a multi-institutional international database, patients treated with either endoscopic papillectomy (EP), transduodenal surgical ampullectomy (TSA), or pancreaticoduodenectomy (PD) for ampullary NEN were included. Clinical features, post-procedure complications, and recurrences were assessed. Results: 65 patients were included, 20 (30.8%) treated with EP, 19 (29.2%) with TSA, and 26 (40%) with PD. Patients were mostly asymptomatic (n = 46; 70.8%). Median tumor size was 17 mm (12-22), tumors were mostly grade 1 (70.8%) and pT2 (55.4%). Two (10%) EP resulted in severe American Society for Gastrointestinal Enterology (ASGE) adverse post-procedure complications and 10 (50%) were R0. Clavien 3-5 complications did not occur after TSA and in 4, including 1 postoperative death (15.4%) of patients after PD, with 17 (89.5%) and 26 R0 resection (100%), respectively. The pN1/2 rate was 51.9% (n = 14) after PD. Tumor size larger than 1 cm (i.e., pT stage >1) was a predictor for R1 resection (p < 0.001). Three-year overall survival and disease-free survival after EP, TSA, and PD were 92%, 68%, 92% and 92%, 85%, 73%, respectively. Conclusion: Management of ampullary NEN is challenging. EP should not be performed in lesions larger than 1 cm or with a endoscopic ultrasonography T stage beyond T1. Local resection by TSA seems safe and feasible for lesions without nodal involvement. PD should be preferred for larger ampullary NEN at risk of nodal metastasis.
(Less)
- author
- Karam, Elias
; Hollenbach, Marcus
; Abou Ali, Einas
; Auriemma, Francesco
; Anderloni, Andrea
; Barbier, Louise
; Belfiori, Giulio
; Caillol, Fabrice
; Crippa, Stefano
; Del Chiaro, Marco
; De Ponthaud, Charles
; Dahel, Yanis
; Falconi, Massimo
; Giovannini, Marc
; Heling, Dominik
; Inoue, Yosuke
; Jarnagin, William R.
; Leung, Galen
; Lupinacci, Renato M.
; Mariani, Alberto
; Masaryk, Viliam
; Miksch, Rainer Christoph
; Musquer, Nicolas
; Napoleon, Bertrand
; Oba, Atsushi
; Partelli, Stefano
; Petrone, Maria C.
; Prat, Frédéric
; Repici, Alessandro
; Sauvanet, Alain
; Salzmann, Katrin
; Schattner, Mark A.
; Schulick, Richard
; Schwarz, Lilian
; Soares, Kevin
; Souche, François R.
; Truant, Stéphanie
; Vaillant, Jean C.
; Wang, Tiegong
; Wedi, Edris
; Werner, Jens
; Weismüller, Tobias J.
; Wichmann, Dörte
; Will, Uwe
; Zaccari, Piera
; Gulla, Aiste
; Heise, Christian
; Regner, Sara
LU
and Gaujoux, Sébastien
(Less) - organization
- publishing date
- 2023-10
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- Ampulla of vater, Ampullary neuroendocrine neoplasia, Endoscopic papillectomy, Pancreaticoduodenectomy, Transduodenal surgical ampullectomy
- in
- Neuroendocrinology
- volume
- 113
- issue
- 10
- pages
- 11 pages
- publisher
- Karger
- external identifiers
-
- pmid:37369186
- scopus:85174640309
- ISSN
- 0028-3835
- DOI
- 10.1159/000531712
- language
- English
- LU publication?
- yes
- id
- 8140f9ee-fe24-46ea-96bb-185e854aef54
- date added to LUP
- 2023-12-12 14:30:00
- date last changed
- 2024-04-25 08:06:43
@article{8140f9ee-fe24-46ea-96bb-185e854aef54,
abstract = {{<p>Introduction: Ampullary neuroendocrine neoplasia (NEN) is rare and evidence regarding their management is scarce. This study aimed to describe clinicopathological features, management, and prognosis of ampullary NEN according to their endoscopic or surgical management. Methods: From a multi-institutional international database, patients treated with either endoscopic papillectomy (EP), transduodenal surgical ampullectomy (TSA), or pancreaticoduodenectomy (PD) for ampullary NEN were included. Clinical features, post-procedure complications, and recurrences were assessed. Results: 65 patients were included, 20 (30.8%) treated with EP, 19 (29.2%) with TSA, and 26 (40%) with PD. Patients were mostly asymptomatic (n = 46; 70.8%). Median tumor size was 17 mm (12-22), tumors were mostly grade 1 (70.8%) and pT2 (55.4%). Two (10%) EP resulted in severe American Society for Gastrointestinal Enterology (ASGE) adverse post-procedure complications and 10 (50%) were R0. Clavien 3-5 complications did not occur after TSA and in 4, including 1 postoperative death (15.4%) of patients after PD, with 17 (89.5%) and 26 R0 resection (100%), respectively. The pN1/2 rate was 51.9% (n = 14) after PD. Tumor size larger than 1 cm (i.e., pT stage >1) was a predictor for R1 resection (p < 0.001). Three-year overall survival and disease-free survival after EP, TSA, and PD were 92%, 68%, 92% and 92%, 85%, 73%, respectively. Conclusion: Management of ampullary NEN is challenging. EP should not be performed in lesions larger than 1 cm or with a endoscopic ultrasonography T stage beyond T1. Local resection by TSA seems safe and feasible for lesions without nodal involvement. PD should be preferred for larger ampullary NEN at risk of nodal metastasis.</p>}},
author = {{Karam, Elias and Hollenbach, Marcus and Abou Ali, Einas and Auriemma, Francesco and Anderloni, Andrea and Barbier, Louise and Belfiori, Giulio and Caillol, Fabrice and Crippa, Stefano and Del Chiaro, Marco and De Ponthaud, Charles and Dahel, Yanis and Falconi, Massimo and Giovannini, Marc and Heling, Dominik and Inoue, Yosuke and Jarnagin, William R. and Leung, Galen and Lupinacci, Renato M. and Mariani, Alberto and Masaryk, Viliam and Miksch, Rainer Christoph and Musquer, Nicolas and Napoleon, Bertrand and Oba, Atsushi and Partelli, Stefano and Petrone, Maria C. and Prat, Frédéric and Repici, Alessandro and Sauvanet, Alain and Salzmann, Katrin and Schattner, Mark A. and Schulick, Richard and Schwarz, Lilian and Soares, Kevin and Souche, François R. and Truant, Stéphanie and Vaillant, Jean C. and Wang, Tiegong and Wedi, Edris and Werner, Jens and Weismüller, Tobias J. and Wichmann, Dörte and Will, Uwe and Zaccari, Piera and Gulla, Aiste and Heise, Christian and Regner, Sara and Gaujoux, Sébastien}},
issn = {{0028-3835}},
keywords = {{Ampulla of vater; Ampullary neuroendocrine neoplasia; Endoscopic papillectomy; Pancreaticoduodenectomy; Transduodenal surgical ampullectomy}},
language = {{eng}},
number = {{10}},
pages = {{1024--1034}},
publisher = {{Karger}},
series = {{Neuroendocrinology}},
title = {{Endoscopic and Surgical Management of Non-Metastatic Ampullary Neuroendocrine Neoplasia : A Multi-Institutional Pancreas2000/EPC Study}},
url = {{http://dx.doi.org/10.1159/000531712}},
doi = {{10.1159/000531712}},
volume = {{113}},
year = {{2023}},
}