Endoscopic and Surgical Management of Non-Metastatic Ampullary Neuroendocrine Neoplasia: A Multi-Institutional Pancreas2000/EPC Study

Elias Karam, Marcus Hollenbach, Einas Abou Ali, Francesco Auriemma, Andrea Anderloni, Louise Barbier, Giulio Belfiori, Fabrice Caillol, Stefano Crippa, Marco Del Chiaro, Charles De Ponthaud, Yanis Dahel, Massimo Falconi, Marc Giovannini, Dominik Heling, Yosuke Inoue, William R. Jarnagin, Galen Leung, Renato M. Lupinacci, Alberto MarianiViliam Masaryk, Rainer Christoph Miksch, Nicolas Musquer, Bertrand Napoleon, Atsushi Oba, Stefano Partelli, Maria C. Petrone, Frédéric Prat, Alessandro Repici, Alain Sauvanet, Katrin Salzmann, Mark A. Schattner, Richard Schulick, Lilian Schwarz, Kevin Soares, François R. Souche, Stéphanie Truant, Jean C. Vaillant, Tiegong Wang, Edris Wedi, Jens Werner, Tobias J. Weismüller, Dörte Wichmann, Uwe Will, Piera Zaccari, Aiste Gulla, Christian Heise, Sara Regner, Sébastien Gaujoux

Forskningsoutput: TidskriftsbidragArtikel i vetenskaplig tidskriftPeer review


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.

Sidor (från-till)1024-1034
Antal sidor11
StatusPublished - 2023 okt.

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