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

Elias Karam, Marcus Hollenbach, Einas Abou Ali, Francesco Auriemma, Aiste Gulla, Christian Heise, Sara Regner, Sébastien Gaujoux, Jean M. Regimbeau, Georg Kähler, Steffen Seyfried, Jean C. Vaillant, Charles De Ponthaud, Alain Sauvanet, David Birnbaum, Nicolas Regenet, Stéphanie Truant, Enrique Pérez-Cuadrado-Robles, Matthieu Bruzzi, Renato M. LupinacciMartin Brunel, Giulio Belfiori, Louise Barbier, Ephrem Salamé, Francois R. Souche, Lilian Schwarz, Laura Maggino, Roberto Salvia, Johan Gagniére, Marco Del Chiaro, Galen Leung, Thilo Hackert, Tobias Kleemann, Woo H. Paik, Karel Caca, Ana Dugic, Steffen Muehldorfer, Brigitte Schumacher, David Albers, Pancreas 2000 Research Group

Research output: Contribution to journalArticlepeer-review


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.

Original languageEnglish
Pages (from-to)1254-1262
Number of pages9
JournalSurgery (United States)
Issue number5
Publication statusPublished - 2023 May

Bibliographical note

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.

Subject classification (UKÄ)

  • Surgery


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