Endoscopic papillectomy versus surgical ampullectomy for adenomas and early cancers of the papilla: a retrospective Pancreas2000/European Pancreatic Club analysis.

Data de publicação: Data Ahead of Print:

Autores da FMUP

  • Mário Jorge Dinis Ribeiro

    Autor

  • Diogo Miguel Pereira Libânio Monteiro

    Autor

Participantes de fora da FMUP

  • Hollenbach M
  • Heise C
  • Abou-Ali E
  • Gulla A
  • Auriemma F
  • Soares K
  • Leung G
  • Schattner MA
  • Jarnagin WR
  • Wang T
  • Caillol F
  • Giovannini M
  • Dahel Y
  • Hackert T
  • Paik WH
  • Zerbi A
  • Nappo G
  • Napoleon B
  • Arnelo U
  • Haraldsson E
  • Halimi A
  • Waldthaler A
  • Will U
  • Saadeh R
  • Masaryk V
  • van der Wiel SE
  • Bruno MJ
  • Perez-Cuadrado-Robles E
  • Deprez P
  • Sauvanet A
  • Bolm L
  • Keck T
  • Souche R
  • Fabre JM
  • Musquer N
  • Kähler G
  • Seyfried S
  • Petrone MC
  • Mariani A
  • Zaccari P
  • Belfiori G
  • Crippa S
  • Falconi M
  • Partelli S
  • Yilmaz B
  • Demir IE
  • Ceyhan GO
  • Satoi S
  • Regimbeau JM
  • Gagniére J
  • Repici A
  • Anderloni A
  • Vollmer C
  • Casciani F
  • Del Chiaro M
  • Oba A
  • Schulick RD
  • Berger A
  • Maggino L
  • Salvia R
  • Schemmer P
  • Wichmann D
  • Inoue Y
  • Laranjo A
  • Kleemann T
  • Sandru V
  • Ilie M
  • Ahola R
  • Laukkarinen J
  • Schumacher B
  • Albers D
  • Cúrdia Gonçalves T
  • Barbier L
  • Salamé E
  • Weismüller TJ
  • Heling D
  • Alves A
  • Karam E
  • Regenet N
  • Dugic A
  • Muehldorfer S
  • Truant S
  • Caca K
  • Meier B
  • Miutescu BP
  • Tantau M
  • Birnbaum D
  • Miksch RC
  • Wedi E
  • Salzmann K
  • Bruzzi M
  • Lupinacci RM
  • David P
  • De Ponthaud C
  • Schmidt A
  • Regnér S
  • Gaujoux S
  • ESAP study group

Unidades de investigação

Abstract

OBJECTIVE: Ampullary neoplastic lesions can be resected by endoscopic papillectomy (EP) or transduodenal surgical ampullectomy (TSA) while pancreaticoduodenectomy is reserved for more advanced lesions. We present the largest retrospective comparative study analysing EP and TSA. DESIGN: Of all patients in the database, lesions with prior interventions, benign histology advanced malignancy (T2 and more), patients with hereditary syndromes and those undergoing pancreatoduodenectomy were excluded. All remaining cases as well as a subgroup of them, after propensity-score matching (nearest-neighbour-method) based on age, gender, anthropometrics, comorbidities, size and histological subtype, were analysed. The median follow-up was 21 months (IQR 10-47) after the primary intervention. Primary outcomes were rates of complete resection (R0) and complications. Groups were compared by Fisher's exact or ?(2) test, Mann-Whitney-U-test and log-rank test for survival. RESULTS: Of 1673 patients in the database, 1422 underwent EP and 251 TSA. Of them, 23.2% were excluded for missing or inconclusive data and 19.8% of patients for prior interventions or hereditary syndromes. Final histology showed in 24.2% of EP and 14.8% of TSA patients a histology other than adenoma or adenocarcinoma while advanced cancers were recorded in 10.9% of EP and 36.6% of TSA patients. Finally, 569 EP and 63 TSA were included in the overall analysis, with a higher rate of more advanced cases and higher R0 resection rates in the TSA groups (90.5% vs 73.1%; p<0.01), with additional ablation in the EP group in 14.4%. Severe adverse event rates were 3.2% (TSA) vs 1.9% (EP). Recurrence after histological R0 resection was 16% (EP) vs 3.2% (TSA; p=0.01), and additional therapy for R1 resection was applied in 67% of the 159 cases. Propensity-score-based matching identified 62 pairs of EP/TSA patients with comparable baseline patient and lesion characteristics. The initial R0-rate was 72.6% (EP) compared with 90.3% (TSA, p=0.02) with recurrences found in 8% (EP) vs 3.2% (TSA; p=0.07); reinterventions were more frequent in the EP group. Overall survival was comparable. CONCLUSIONS: The rate of patients with poor indications due to non-neoplastic disease or advanced cancer is still high for both EP and TSA; multiple retreatments were necessary for EP. Although EP can be considered an appropriate primary therapy for certain ampullary adenomas, case selection for both therapies (especially with regard to the best step-up approach) should be studied further.

© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.

Dados da publicação

ISSN/ISSNe:
1468-3288, 0017-5749

Gut  BMJ Publishing Group

Tipo:
Article
Páginas:
397-409
Link para outro recurso:
www.scopus.com

Documentos

  • Não há documentos

Métricas

Filiações mostrar / ocultar

Keywords

  • ENDOSCOPIC PROCEDURES; ENDOSCOPIC RETROGRADE PANCREATOGRAPHY; PANCREATIC CANCER; PANCREATIC TUMOURS; PANCREATICODUODENECTOMY

Proyectos asociados

Individualized gastric adenocarcinoma early diagnosis and improved patients survival: from liquid biopsies to a comprehensive management approach. (IMAGE)

Investigador Principal: Mário Jorge Dinis Ribeiro

Estudo Clínico Académico (IMAGE) . AgênciaD&amp;C . 2021

Effectiveness of endoscopic resection of colonic lesions > 20mm

Investigador Principal: Mário Jorge Dinis Ribeiro

Estudo Clínico Académico (Colonic lesions) . 2020

Prevalence and Prognostic Importance of Occult Tumor Cells in Gastric Cancer

Investigador Principal: Mário Jorge Dinis Ribeiro

Estudo Clínico Académico . 2022

Citar a publicação

Partilhar a publicação