TY - JOUR
T1 - Endoscopic and Surgical Management of Non-Metastatic Ampullary Neuroendocrine Neoplasia
T2 - A Multi-Institutional Pancreas2000/EPC Study
AU - Karam, Elias
AU - Hollenbach, Marcus
AU - Abou Ali, Einas
AU - Auriemma, Francesco
AU - Anderloni, Andrea
AU - Barbier, Louise
AU - Belfiori, Giulio
AU - Caillol, Fabrice
AU - Crippa, Stefano
AU - Del Chiaro, Marco
AU - De Ponthaud, Charles
AU - Dahel, Yanis
AU - Falconi, Massimo
AU - Giovannini, Marc
AU - Heling, Dominik
AU - Inoue, Yosuke
AU - Jarnagin, William R.
AU - Leung, Galen
AU - Lupinacci, Renato M.
AU - Mariani, Alberto
AU - Masaryk, Viliam
AU - Miksch, Rainer Christoph
AU - Musquer, Nicolas
AU - Napoleon, Bertrand
AU - Oba, Atsushi
AU - Partelli, Stefano
AU - Petrone, Maria C.
AU - Prat, Frédéric
AU - Repici, Alessandro
AU - Sauvanet, Alain
AU - Salzmann, Katrin
AU - Schattner, Mark A.
AU - Schulick, Richard
AU - Schwarz, Lilian
AU - Soares, Kevin
AU - Souche, François R.
AU - Truant, Stéphanie
AU - Vaillant, Jean C.
AU - Wang, Tiegong
AU - Wedi, Edris
AU - Werner, Jens
AU - Weismüller, Tobias J.
AU - Wichmann, Dörte
AU - Will, Uwe
AU - Zaccari, Piera
AU - Gulla, Aiste
AU - Heise, Christian
AU - Regner, Sara
AU - Gaujoux, Sébastien
PY - 2023/10
Y1 - 2023/10
N2 - 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.
AB - 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.
KW - Ampulla of vater
KW - Ampullary neuroendocrine neoplasia
KW - Endoscopic papillectomy
KW - Pancreaticoduodenectomy
KW - Transduodenal surgical ampullectomy
U2 - 10.1159/000531712
DO - 10.1159/000531712
M3 - Article
C2 - 37369186
AN - SCOPUS:85174640309
SN - 0028-3835
VL - 113
SP - 1024
EP - 1034
JO - Neuroendocrinology
JF - Neuroendocrinology
IS - 10
ER -