Development and external validation of a prediction model for survival in patients with resected ampullary adenocarcinoma

Moekotte, Alma; Roessel, Stijn van; Malleo, Giuseppe; Rajak, Rushda; Ecker, Brett L.; Fontana, Martina; Han, Ho Seong; Rabie, Mohamed; Roberts, Keith; Khalil, Khalid; White, Steven A.; Robinson, Stuart; Halimi, Asif; Zarantonello, Laura; Fusai, Giuseppe; Gradinariu, George; Bonds, Morgan; Dreyer, Stephan; Jamieson, Nigel B.; Mowbray, Nicholas; Al-Sarireh, Bilal; Mavroeidis, Vasileios; Soonawalla, Zahir; Napoli, Niccolò; Boggi, Ugo; Kent, Tara S.; Fisher, William E.; Tang, Chung Ngai; Bolm, Louisa; House, Michael G.; Dillhoff, Mary; Behrman, Stephen W.; Nakamura, Masafumi; Ball, Chad G.; Berger, Adam C.; Christein, John D.; Zureikat, Amer H.; Salem, Ronald R.; Vollmer, Charles M.; Salvia, Roberto; Besselink, Marc G.; Hilal, Mohammed Abu; Al-Jarrah, R.; Barrows, Courtney E.; Cagigas, Martha N.; Lai, Eric C. H.; Wellner, Ulrich F.; Aversa, John; Dickson, Paxton V.; Ohtsuka, Takao; Dixon, Elijah; Zheng, Richard; Kowalski, Stacy; Freedman-Weiss, Mollie

doi:10.1016/j.ejso.2020.04.011

Cited by 22 publications

(14 citation statements)

References 36 publications

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“…In fact, hilar invasion of ampullary cancer was not observed in this study. In past reports that have described the results of treatment or surgery for ampullary cancer, pancreaticobiliary type, lymph node metastasis, advanced T stage, and large tumors were identi ed as risk factors for poor prognosis [36][37][38][39][40][41]. Hilar biliary invasion was not listed as a risk factor in these reports.…”

Section: Discussionmentioning

confidence: 98%

Screening for Hilar Biliary Invasion in Ampullary Cancer Patients

Sugimoto¹,

Takagi²,

Suzuki³

et al. 2021

Preprint

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Background: The treatment for ampullary cancer is pancreatoduodenectomy or local ampullectomy. However, effective methods for the preoperative investigation of hilar biliary invasion in ampullary cancer patients have not yet been identified. In this study, we aimed to determine an appropriate method for investigating hilar biliary invasion of ampullary cancer.Methods: Among 43 ampullary cancer patients, 34 underwent endoscopic treatment (n = 9) or surgery (n = 25). Imaging findings (thickening and enhancement of the bile duct wall on contrast-enhanced CT (CECT), irregularity on endoscopic retrograde cholangiography (ERC), thickening of the entire bile duct wall on intraductal ultrasonography (IDUS), and partial thickening of the bile duct wall on IDUS) and biliary biopsy results were compared with respect to their ability to diagnose hilar biliary invasion of ampullary cancer.Results: Hilar invasion was not observed in every patient. Among the patients who did not undergo biliary stent insertion, the combination of partial thickening of the bile duct wall on IDUS and biliary biopsy showed the highest accuracy (100%) for diagnosing biliary invasion. However, each imaging finding and biliary biopsy yielded some false positive results.Conclusions: Although some false positive results were obtained with each method, the combination of partial thickening of the bile duct wall on IDUS and biliary biopsy was useful for diagnosing hilar biliary invasion of ampullary cancer. However, hilar invasion of ampullary cancer is rare; therefore, the investigation of hilar biliary invasion of ampullary cancer might be unnecessary.Trial registration: not applicable

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Section: Discussionmentioning

confidence: 98%

Screening for Hilar Biliary Invasion in Ampullary Cancer Patients

Sugimoto¹,

Takagi²,

Suzuki³

et al. 2021

Preprint

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“…PD is always possible, however patient comorbidities and postoperative morbidity should always be taken into account when planning a PD. As for the role of systemic therapy, associating surgery with chemotherapy seems to be effective in more advanced stages of disease, either as adjuvant or neoadjuvant treatment (87)(88)(89).…”

Section: Diagnostic and Treatment Algorithmmentioning

confidence: 99%

From endoscopic resection to pancreatoduodenectomy: a narrative review of treatment modalities for the tumors of the ampulla of Vater

Taliente¹,

Bianco²,

Moschetta³

et al. 2022

Chin Clin Oncol

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Background and Objective: Tumors of the ampulla of Vater are a rare set of lesions that arise at the confluence of the common bile duct (CBD) and the pancreatic duct. They can be benign or malignant, often not easy to discriminate before treatment. Malignant tumors have low chances of survival (overall 5-year survival between 0% and 60%) and surgery is still the only curative option. Prognostic factors are being investigated to tailor therapeutic approach and improve outcomes. Due to their location in a complex anatomical region, all treatment options are challenging and associated with relevant morbidity. In this review we discuss different excisional techniques for the treatment of ampullary tumors (AT).Methods: A review of medical databases (PubMed and Google Scholar) was conducted selecting most relevant articles in English language without a specific timeframe. After first selection, most relevant citations were identified through snowballing.Key Content and Findings: Pancreatoduodenectomy (PD) is the gold standard in malignant tumors, achieving the most radical treatment, at the price of worse perioperative morbidity/mortality and quality of life. Trans-duodenal ampullectomy (TDA) was developed before endoscopic resection (ER) and maintains a role only in selected patients. ER is now the first choice for benign lesions and expanding towards early stages malignant AT.Conclusions: Pancreatodudenectomy remains the best option for the radical excision of malignant AT, recently being offered also via minimally invasive approach. However, in early-stage malignant tumors, ER is gaining importance with foreseeable further expansion. Transduodenal ampullectomy still has a role in selected patients, such as unfit for PD when ER is not possible mainly due to anatomical abnormalities.

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“…The role of SA as a treatment for AAC has been extensively debated. Particular attention has been paid to predictors of lymph node metastasis, as this may be the major factor responsible for recurrence following SA, and is also associated with poor prognosis[ 2 , 4 , 32 , 56 ]. It has been widely recognized that PD is the most effective treatment for ampullary cancer[ 6 ].…”

Section: Indicationsmentioning

confidence: 99%

“…Ampullary adenocarcinoma (AAC) is the most common cancer of the ampulla of Vater, but represents only 7% of peri-ampullary cancers, and fewer than 1% of all cancers of the digestive system[ 1 , 2 ]. Its prognosis is relatively favourable compared to other cancers near the ampulla: 5-year survival is 41.5%-53% following surgical resection[ 1 , 3 , 4 ]. AACs are widely believed to develop within adenomas following an adenoma-carcinoma sequence[ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Surgical ampullectomy: A comprehensive review

Scroggie¹,

Mavroeidis²

2021

WJGS

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Tumours of the ampulla of Vater are relatively uncommon lesions of the digestive system. They are typically diagnosed at an earlier stage than other types of tumours in this region, due to their tendency to invoke symptoms by obstructing the bile duct or pancreatic duct. Consequently, many are potentially curable by excision. Surgical ampullectomy (SA) (or transduodenal ampullectomy) for an ampullary tumour was first described in 1899, but was soon surpassed by pancreatoduodenectomy (PD), which offered a more extensive resection resulting in a lower risk of recurrence. Ongoing innovation in endoscopic techniques over recent decades has led to the popularization of endoscopic papillectomy (EP), particularly for adenomas and even early cancers. The vast majority of resectable ampullary tumours are now treated using either PD or EP. However, SA continues to play a role in specific circumstances. Many authors have suggested specific indications for SA based on their own data, practices, or interpretations of the literature. However, certain issues have attracted controversy, such as its use for early ampullary cancers. Consequently, there has been a lack of clarity regarding indications for SA, and no evidence-based consensus guidelines have been produced. All studies reporting SA have employed observational designs, and have been heterogeneous in their methodologies. Accordingly, characteristics of patients and their tumours have differed substantially across treatment groups. Therefore, meaningful comparisons of clinical outcomes between SA, PD and EP have been elusive. Nevertheless, it appears that suitably selected cases of ampullary tumours subjected to SA may benefit from favourable peri-operative and long-term outcomes with very low mortality and significantly long survival, hence its role in this setting warrants further clarification, while it can also be useful in the management of specific benign entities. Whilst the commissioning of a randomised controlled trial seems unlikely, well-designed observational studies incorporating adjustments for confounding variables may become the best available comparative evidence for SA, potentially informing the eventual development of consensus guidelines. In this comprehensive review, we explore the role of SA in the modern management of ampullary lesions.

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Development and external validation of a prediction model for survival in patients with resected ampullary adenocarcinoma

Cited by 22 publications

References 36 publications

Screening for Hilar Biliary Invasion in Ampullary Cancer Patients

Screening for Hilar Biliary Invasion in Ampullary Cancer Patients

From endoscopic resection to pancreatoduodenectomy: a narrative review of treatment modalities for the tumors of the ampulla of Vater

Surgical ampullectomy: A comprehensive review

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