Controversies in the diagnosis and treatment of periampullary tumours

Skórzewska, Magdalena; Kurzawa, Paweł; Ciszewski, Tomasz; Pelc, Zuzanna; Polkowski, Wojciech

doi:10.1016/j.suronc.2022.101853

Cited by 10 publications

(10 citation statements)

References 27 publications

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“…Moreover, many studies have reported controversial results regarding the extent of lymphadenectomy [ 16 ]. Apart from the surgical strategy, the role of adjuvant treatment for AC also remains controversial [ 17 , 18 , 19 ]. As mentioned above, there are diverse treatment strategies for AC.…”

Section: Discussionmentioning

confidence: 99%

The Optimal Cutoff Value of Tumor Markers for Prognosis Prediction in Ampullary Cancer

Lee

Kim

Sohn

et al. 2023

Cancers

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Background: Carbohydrate antigen 19-9 (CA 19-9) is a representative tumor marker used for the diagnosis of pancreatic and biliary tract cancers. There are few published research results that can be applied to actual clinical practice for ampullary cancer (AC) alone. This study aimed to demonstrate the relationship between the prognosis of AC and the level of CA 19-9, and to determine the optimal thresholds. Methods: Patients who underwent curative resection (pancreaticoduodenectomy (PD) or pylorus preserving pancreaticoduodenectomy (PPPD)) for AC at the Seoul National University Hospital between January 2000 and December 2017 were enrolled. To determine the optimal cutoff values that could clearly stratify the survival outcome, the conditional inference tree (C-tree) method was used. After obtaining the optimal cutoff values, they were compared to the upper normal clinical limit of 36 U/mL for CA 19-9. Results In total, 385 patients were enrolled in this study. The median value of the tumor marker CA 19-9 was 18.6 U/mL. Using the C-tree method, 46 U/mL was determined to be the optimal cutoff value for CA 19-9. Histological differentiation, N stage, and adjuvant chemotherapy were significant predictors. CA 19-9 36 U/mL had marginal significance as a prognostic factor. In contrast, the new cutoff value, CA 19-9 46 U/mL, was found to be a statistically significant prognostic factor (HR: 1.37, p = 0.048). Conclusions: The new cutoff value of CA 19-9 46 U/mL may be used for evaluating the prognosis of AC. Therefore, it may be an effective indicator for determining treatment strategies such as surgical treatments and adjuvant chemotherapy.

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Section: Discussionmentioning

confidence: 99%

The Optimal Cutoff Value of Tumor Markers for Prognosis Prediction in Ampullary Cancer

Lee

Kim

Sohn

et al. 2023

Cancers

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“…Differentiation among histologic types preoperatively is difficult due to the proximity of the structures and their similar immunophenotype. Molecular characterization can be used for objective classification and targeted therapy (3,(4)(5)(6) However, despite their anatomical proximity and similar operative approach, these cancers have demonstrated a large disparity in outcomes. Currently, the most studied prognostic factors associated with disease-free survival (DFS) and overall survival (OS) are the resection margins, tumoral biology, vascular invasion, and lymph node metastasis (4)(5)(6).…”

Section: Introductionmentioning

confidence: 99%

“…During this procedure, resection of the hepatic artery node is performed routinely in most places to dissect and visualize the emergency of the gastroduodenal artery but is not mandatory in lymph node dissection (4,(8)(9)(10). The 8th edition of the TNM classification recommends pathologic examination of at least 12 nodes for reliable assessment of the lymphatic status (3). It has been identified in previous pancreatic cancer studies that the compromise of the hepatic artery lymph node (HALN), also called station 8a, a second-echelon node according to the Japan Pancreas Society classification (7) can be related to a reduction of OS (11).…”

Section: Introductionmentioning

confidence: 99%

“…In rare cases, metastases from another primary cancer may be located in the periampullary region. The most frequent cancer type is renal cell carcinoma ( 3 ). Periampullary cancers arising from the duodenum, ampulla, and CBD are associated with better survival than pancreatic cancer and this may be related to tumor biology and more aggressive behavior ( 2 ).…”

Section: Introductionmentioning

confidence: 99%

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Hepatic artery lymph node relevance in periampullary tumors: A retrospective analysis of survival outcomes

et al. 2022

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BackgroundThe Periampullary area comprehends a heterogeneous and complex structure with different histological tissues. Surgical standards include the peripancreatic regional lymphadenectomy, and during pancreatoduodenectomy (PD) the hepatic artery lymph node HALN(8a) is dissected. We aimed to describe the prognostic significance of the HALN(8a) lymph node metastasis in terms of disease-free survival (DFS) and overall survival (OS) in a specific cohort of patients in limited economic and social conditions.MethodsA retrospective study was conducted based on a prospective database from the HPB department of patients who underwent pancreaticoduodenectomy (PD) due to periampullary tumors during 2014–2021. Overall survival (OS) and disease-free survival (DFS) were estimated to be associated with positive HALN(8a) using Kaplan-Meier analysis. Log Rank test and Cox proportional hazards regression analysis was used.Results111 patients were included, 55,4% female. The most frequent pathology was ductal adenocarcinoma (60.3%). The positive rate of the HALN(8a) node was 21.62%. The Median OS time was 25.5 months, and the median DFS time was 13,8 months. Positive HLAN(8a) node, the cutoff of lymph node ratio resection (LNRR), and vascular invasion showed a strong association with OS. (CoxRegression p = 0.03 HR 0.5, p 0.003 HR = 1.8, p = 0.02 HR 0.4 CI 95%). In terms of DFS, lymph node ratio cutoff, tumoral size, and vascular invasion showed a statistically significant association with the outcome (p = 0.008, HR = 1.5; p = 0.04 HR = 2.1; p = 0.02 HR = 0.4 CI 95%).ConclusionIn this series of PD, OS was reduced in patients with HALN(8a) compromise in patients with pancreatic cancer, however without statistical significance in DFS. In multivariate analysis, lymph node status remains an independent predictor of OS and DFS. Further studies are needed.

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“…Distal bile duct cholangiocarcinoma, ampullary adenocarcinoma, duodenal carcinoma, and ductal adenocarcinoma (PDAC) of the head of the pancreas usually have similar clinical presentation since they arise in the same circumscribed anatomical area, within 2 cm of the major duodenal papilla. For this reason, it is not uncommon to experience misdiagnosis during the diagnostic workup [ 1 , 2 ].…”

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confidence: 99%