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Outcomes of rescue procedures in the management of locally recurrent ampullary tumors : A Pancreas 2000/EPC study

Karam, Elias ; Hollenbach, Marcus ; Ali, Einas Abou ; Auriemma, Francesco ; Gulla, Aiste ; Heise, Christian ; Regner, Sara LU orcid ; Gaujoux, Sébastien ; Regimbeau, Jean M. and Kähler, Georg , et al. (2023) In Surgery (United States) 173(5). p.1254-1262
Abstract

Background: Ampullary lesions are rare and can be locally treated either with endoscopic papillectomy or transduodenal surgical ampullectomy. Management of local recurrence after a first-line treatment has been poorly studied. Methods: Patients with a local recurrence of an ampullary lesion initially treated with endoscopic papillectomy or transduodenal surgical ampullectomy were retrospectively included from a multi-institutional database (58 centers) between 2005 and 2018. Results: A total of 103 patients were included, 21 (20.4%) treated with redo endoscopic papillectomy, 14 (13.6%) with transduodenal surgical ampullectomy, and 68 (66%) with pancreaticoduodenectomy. Redo endoscopic papillectomy had low morbidity with 4.8% (n = 1)... (More)

Background: Ampullary lesions are rare and can be locally treated either with endoscopic papillectomy or transduodenal surgical ampullectomy. Management of local recurrence after a first-line treatment has been poorly studied. Methods: Patients with a local recurrence of an ampullary lesion initially treated with endoscopic papillectomy or transduodenal surgical ampullectomy were retrospectively included from a multi-institutional database (58 centers) between 2005 and 2018. Results: A total of 103 patients were included, 21 (20.4%) treated with redo endoscopic papillectomy, 14 (13.6%) with transduodenal surgical ampullectomy, and 68 (66%) with pancreaticoduodenectomy. Redo endoscopic papillectomy had low morbidity with 4.8% (n = 1) severe to fatal complications and a R0 rate of 81% (n = 17). Transduodenal surgical ampullectomy and pancreaticoduodenectomy after a first procedure had a higher morbidity with Clavien III and more complications, respectively, 28.6% (n = 4) and 25% (n = 17); R0 resection rates were 85.7% (n = 12) and 92.6% (n = 63), both without statistically significant difference compared to endoscopic papillectomy (P = .1 and 0.2). Pancreaticoduodenectomy had 4.4% (n = 2) mortality. No deaths were registered after transduodenal surgical ampullectomy or endoscopic papillectomy. Recurrences treated with pancreaticoduodenectomy were more likely to be adenocarcinomas (79.4%, n = 54 vs 21.4%, n = 3 for transduodenal surgical ampullectomy and 4.8%, n = 1 for endoscopic papillectomy, P < .0001). Three-year overall survival and disease-free survival were comparable. Conclusion: Endoscopy is appropriate for noninvasive recurrences, with resection rate and survival outcomes comparable to surgery. Surgery applies more to invasive recurrences, with transduodenal surgical ampullectomy rather for carcinoma in situ and early cancers and pancreaticoduodenectomy for more advanced tumors.

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type
Contribution to journal
publication status
published
subject
in
Surgery (United States)
volume
173
issue
5
pages
9 pages
publisher
Elsevier
external identifiers
  • pmid:36642655
  • scopus:85146455162
ISSN
0039-6060
DOI
10.1016/j.surg.2022.12.011
language
English
LU publication?
yes
additional info
Funding Information: This work was performed and written as part of a project of the eighth Pancreas 2000 program funded and organized by the European Pancreatic Club. Publisher Copyright: © 2022 Elsevier Inc.
id
f9227a24-3d5d-47f7-9b25-cbbcf86ab6bf
date added to LUP
2024-01-15 13:08:59
date last changed
2024-04-30 01:36:54
@article{f9227a24-3d5d-47f7-9b25-cbbcf86ab6bf,
  abstract     = {{<p>Background: Ampullary lesions are rare and can be locally treated either with endoscopic papillectomy or transduodenal surgical ampullectomy. Management of local recurrence after a first-line treatment has been poorly studied. Methods: Patients with a local recurrence of an ampullary lesion initially treated with endoscopic papillectomy or transduodenal surgical ampullectomy were retrospectively included from a multi-institutional database (58 centers) between 2005 and 2018. Results: A total of 103 patients were included, 21 (20.4%) treated with redo endoscopic papillectomy, 14 (13.6%) with transduodenal surgical ampullectomy, and 68 (66%) with pancreaticoduodenectomy. Redo endoscopic papillectomy had low morbidity with 4.8% (n = 1) severe to fatal complications and a R0 rate of 81% (n = 17). Transduodenal surgical ampullectomy and pancreaticoduodenectomy after a first procedure had a higher morbidity with Clavien III and more complications, respectively, 28.6% (n = 4) and 25% (n = 17); R0 resection rates were 85.7% (n = 12) and 92.6% (n = 63), both without statistically significant difference compared to endoscopic papillectomy (P = .1 and 0.2). Pancreaticoduodenectomy had 4.4% (n = 2) mortality. No deaths were registered after transduodenal surgical ampullectomy or endoscopic papillectomy. Recurrences treated with pancreaticoduodenectomy were more likely to be adenocarcinomas (79.4%, n = 54 vs 21.4%, n = 3 for transduodenal surgical ampullectomy and 4.8%, n = 1 for endoscopic papillectomy, P &lt; .0001). Three-year overall survival and disease-free survival were comparable. Conclusion: Endoscopy is appropriate for noninvasive recurrences, with resection rate and survival outcomes comparable to surgery. Surgery applies more to invasive recurrences, with transduodenal surgical ampullectomy rather for carcinoma in situ and early cancers and pancreaticoduodenectomy for more advanced tumors.</p>}},
  author       = {{Karam, Elias and Hollenbach, Marcus and Ali, Einas Abou and Auriemma, Francesco and Gulla, Aiste and Heise, Christian and Regner, Sara and Gaujoux, Sébastien and Regimbeau, Jean M. and Kähler, Georg and Seyfried, Steffen and Vaillant, Jean C. and De Ponthaud, Charles and Sauvanet, Alain and Birnbaum, David and Regenet, Nicolas and Truant, Stéphanie and Pérez-Cuadrado-Robles, Enrique and Bruzzi, Matthieu and Lupinacci, Renato M. and Brunel, Martin and Belfiori, Giulio and Barbier, Louise and Salamé, Ephrem and Souche, Francois R. and Schwarz, Lilian and Maggino, Laura and Salvia, Roberto and Gagniére, Johan and Del Chiaro, Marco and Leung, Galen and Hackert, Thilo and Kleemann, Tobias and Paik, Woo H. and Caca, Karel and Dugic, Ana and Muehldorfer, Steffen and Schumacher, Brigitte and Albers, David}},
  issn         = {{0039-6060}},
  language     = {{eng}},
  number       = {{5}},
  pages        = {{1254--1262}},
  publisher    = {{Elsevier}},
  series       = {{Surgery (United States)}},
  title        = {{Outcomes of rescue procedures in the management of locally recurrent ampullary tumors : A Pancreas 2000/EPC study}},
  url          = {{http://dx.doi.org/10.1016/j.surg.2022.12.011}},
  doi          = {{10.1016/j.surg.2022.12.011}},
  volume       = {{173}},
  year         = {{2023}},
}