Ampullary Carcinoma: An Overview of a Rare Entity and Discussion of Current and Future Therapeutic Challenges

Pinter

et al. 2022

Cancers

Using national registries, we investigated the epidemiological trends of hepatobiliary carcinomas in Austria between 2010 and 2018 and compared them to those reported for the periods of 1990–1999 and 2000–2009. In total, 12,577 patients diagnosed with hepatocellular carcinoma (n = 7146), intrahepatic cholangiocarcinoma (n = 1858), extrahepatic cholangiocarcinoma (n = 1649), gallbladder carcinoma (n = 1365), and ampullary carcinoma (n = 559), between 2010 and 2018, were included. The median overall survival of all patients was 9.0 months. The best median overall survival was observed in patients with ampullary carcinoma (28.5 months) and the worst median overall survival was observed in patients with intrahepatic carcinoma (5.6 months). The overall survival significantly improved in all entities over the period 2010–2018 as compared with over the periods of 2000–2009 and 1990–1999. Age-adjusted incidence and mortality rates remained stable for most entities in both, men and women; only in gallbladder carcinoma, the incidence and mortality rates significantly decreased in women, whereas, in men, the incidence rates remained stable and mortality rates showed a decreasing trend. We showed that age-adjusted incidence and mortality rates were stable in most entities, except in gallbladder carcinoma. The overall survival improved in almost all entities as compared with those during 1990–2009.

Section: Discussionmentioning

confidence: 68%

Changing Epidemiological Trends of Hepatobiliary Carcinomas in Austria 2010–2018

Pinter

et al. 2022

Cancers

“…In this study, various chemotherapy regimens were used, such as the combination of gemcitabine with cisplatin, S1, or cisplatin and S1 (14). Accordingly, further investigation with high evidence-based trials should be performed in order to provide more evidence regarding biological and histological features, and therapeutic strategies (15).…”

Section: Discussionmentioning

confidence: 99%

Prognostic Value of the Regional Lymph Node Station in Pancreatoduodenectomy for Ampullary Carcinoma

Takagi

Nagai

Umeda

et al. 2022

In Vivo

Background/Aim: The optimal extent of lymph node dissection for ampullary carcinoma is controversial. The aim of this study was to investigate the efficacy of lymph node dissection for ampullary carcinoma. Patients and Methods: Between 2000 and 2020, a total of 75 patients undergoing radical resection for ampullary carcinoma were included. The efficacy index (EI) was calculated by multiplication of the frequency of lymph node metastasis (LNM) at the station and the 5-year survival rate of patients with metastasis at the station. Results: Out of 75 patients, 14 had LNM. The EI for the peri-pancreatic head (station 13 and 17) and superior mesenteric artery (station 14) lymph node were 4.4 and 3.5, respectively. Whereas the peri-gastric (station 5 and 6), common hepatic artery (station 8), and liver hilum (station 12) lymph node stations had zero EI. Although the number of patients with the station 16 dissected was small (9%), the para-aortic (station 16) lymph nodes had the highest EI of 14.3 despite being distant lymph nodes. Conclusion: We identified the distribution of LNM and survival benefit of lymph node dissection for ampullary carcinoma. Our results suggest that the optimal extent of lymph node dissection for ampullary carcinoma could be reconsidered.Ampullary carcinoma of the duodenum, or carcinoma of the papilla of Vater, is a rare malignant neoplasm arising from the region of Vater's ampulla. Radical resection with pancreatoduodenectomy is the standard treatment for ampullary carcinoma (1); however, the significance of the optimal lymph node dissection on outcomes remains unclear. Although the Japanese guideline for ampullary carcinoma has proposed the optimal extent of lymph node dissection (2), the impact of the lymph node station dissected on the prognostic survival benefit is still unknown (3). Furthermore, data on long-term outcomes such as survival and recurrence patterns are limited (4, 5).The efficacy index (EI) has been proposed as a useful index to evaluate the therapeutic value of lymph node dissection for gastric cancer (6), and validated for various gastrointestinal and hepatopancreatobiliary cancers (7-9). However, to date, the impact of lymph node dissection on outcomes using the EI has not yet been examined in patients following radical resection for ampullary carcinoma.The aim of this study was to evaluate the efficacy of lymph node dissection using the EI as well as to determine the optimal extent of lymph node dissection for ampullary carcinoma. Moreover, long-term outcomes including survival and recurrence patterns were investigated. Patients and MethodsPatients and study design. The study protocol was approved by the Ethics Committee at our institution (approval no. 2110-003) and conducted according to the Declaration of Helsinki. We performed a retrospective review of the clinical database including 75 patients who underwent radical resection with pancreatoduodenectomy for ampullary carcinoma at the

Vet Record Case Reports

“…Neoplasms from this location can have differentiation towards biliary, pancreatic or duodenal due to the cells present in this location, and diagnosis is based on the neoplasm being centred in this area 6 . In people, the World Health Organization (WHO) subtypes these ampullary carcinomas into pancreaticobiliary, intestinal and mixed (which accounts for up to 40% of these neoplasms in people) 8 . There is some disagreement as to when to diagnose a mixed type as well as the prognostic significance in people 8 .…”

Section: Discussionmentioning

confidence: 99%

Ampullary carcinoma in a sloth bear (Melursus ursinus)

McLean

Pope²

2022

A 26‐year‐old, 126‐kg (277‐lb), entire, female sloth bear (Melursus ursinus) was evaluated following a 2‐week history of hyporexia and lethargy. Diagnostic work‐up revealed peritoneal effusion and elevated liver enzymes. Abdominal exploratory surgery revealed a firm omental mass, a focal lesion within the wall of the pyloric outflow tract and a uniformly thickened gall bladder. Biopsy results were indicative of carcinomatosis with an undetermined primary. These results along with the patient's quick deterioration led to humane euthanasia. Postmortem histopathological examination supported the diagnosis of ampullary carcinoma with carcinomatosis, extensive lymphatic invasion and lymph node, hepatic and pulmonary metastasis. Further investigation is needed to determine best diagnostic modalities and treatment options in ursids diagnosed with ampullary carcinoma. To the authors’ knowledge, this is the first documented report of carcinoma of the ampulla of Vater in an ursid.