TY - JOUR
T1 - Outcomes of rescue procedures in the management of locally recurrent ampullary tumors
T2 - A Pancreas 2000/EPC study
AU - Karam, Elias
AU - Hollenbach, Marcus
AU - Ali, Einas Abou
AU - Auriemma, Francesco
AU - Gulla, Aiste
AU - Heise, Christian
AU - Regner, Sara
AU - Gaujoux, Sébastien
AU - Regimbeau, Jean M.
AU - Kähler, Georg
AU - Seyfried, Steffen
AU - Vaillant, Jean C.
AU - De Ponthaud, Charles
AU - Sauvanet, Alain
AU - Birnbaum, David
AU - Regenet, Nicolas
AU - Truant, Stéphanie
AU - Pérez-Cuadrado-Robles, Enrique
AU - Bruzzi, Matthieu
AU - Lupinacci, Renato M.
AU - Brunel, Martin
AU - Belfiori, Giulio
AU - Barbier, Louise
AU - Salamé, Ephrem
AU - Souche, Francois R.
AU - Schwarz, Lilian
AU - Maggino, Laura
AU - Salvia, Roberto
AU - Gagniére, Johan
AU - Del Chiaro, Marco
AU - Leung, Galen
AU - Hackert, Thilo
AU - Kleemann, Tobias
AU - Paik, Woo H.
AU - Caca, Karel
AU - Dugic, Ana
AU - Muehldorfer, Steffen
AU - Schumacher, Brigitte
AU - Albers, David
AU - Pancreas 2000 Research Group
N1 - 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.
PY - 2023/5
Y1 - 2023/5
N2 - 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.
AB - 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.
U2 - 10.1016/j.surg.2022.12.011
DO - 10.1016/j.surg.2022.12.011
M3 - Article
C2 - 36642655
AN - SCOPUS:85146455162
SN - 0039-6060
VL - 173
SP - 1254
EP - 1262
JO - Surgery (United States)
JF - Surgery (United States)
IS - 5
ER -
