The role of mesopancreas excision for ampullary carcinomas: a single center propensity-score matched analysis

Quero, Giuseppe; Fiorillo, Claudio; Sio, Davide De; Laterza, Vito; Menghi, Roberta; Cina, Caterina; Schena, Carlo Alberto; Rosa, Fausto; Galiandro, Federica; Alfieri, Sergio

doi:10.1016/j.hpb.2021.03.011

Cited by 12 publications

(11 citation statements)

References 34 publications

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“…In our hands, PB type, pT3 stage, and lymph node metastases were associated with lower OS; other variables scrutinized were not significantly associated with OS. The low rate of locoregional recurrence reported in our cohort could be partly explained by the application of level 2 mesopancreas resection, in accordance with the data by Quero and collaborators[ 34 ].…”

Section: Discussionsupporting

confidence: 93%

“…In this study, the authors report 32% locoregional recurrence, despite the median number of retrieved lymph nodes and the low number of patients with R1 resection. Moreover, Quero and collaborators recently corroborated this finding about no difference between INT- and PB-types, but higher overall and recurrence-free survivals with excision of the mesopancreas[ 34 ].…”

Section: Discussionmentioning

confidence: 75%

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Survival after curative pancreaticoduodenectomy for ampullary adenocarcinoma in a South American population: A retrospective cohort study

Fernandez-Placencia¹,

Montenegro²,

Guerrero³

et al. 2022

WJGS

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BACKGROUND Ampullary adenocarcinoma (AAC) is a rare neoplasm that accounts for only 0.2% of all gastrointestinal cancers. Its incidence rate is lower than 6 cases per million people. Different prognostic factors have been described for AAC and are associated with a wide range of survival rates. However, these studies have been exclusively conducted in patients originating from Asian, European, and North American countries. AIM To evaluate the histopathologic predictors of overall survival (OS) in South American patients with AAC treated with curative pancreaticoduodenectomy (PD). METHODS We analyzed retrospective data from 83 AAC patients who underwent curative (R0) PD at the National Cancer Institute of Peru between January 2010 and October 2020 to identify histopathologic predictors of OS. RESULTS Sixty-nine percent of patients had developed intestinal-type AAC (69%), 23% had pancreatobiliary-type AAC, and 8% had other subtypes. Forty-one percent of patients were classified as Stage I, according to the AJCC 8 th Edition. Recurrence occurred primarily in the liver ( n = 8), peritoneum ( n = 4), and lung ( n = 4). Statistical analyses indicated that T3 tumour stage [hazard ratio (HR) of 6.4, 95% confidence interval (CI) of 2.5-16.3, P < 0.001], lymph node metastasis (HR: 4.5, 95%CI: 1.8-11.3, P = 0.001), and pancreatobiliary type (HR: 2.7, 95%CI: 1.2-6.2, P = 0.025) were independent predictors of OS. CONCLUSION Extended tumour stage (T3), pancreatobiliary type, and positive lymph node metastasis represent independent predictors of a lower OS rate in South American AAC patients who underwent curative PD.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 75%

Survival after curative pancreaticoduodenectomy for ampullary adenocarcinoma in a South American population: A retrospective cohort study

Fernandez-Placencia¹,

Montenegro²,

Guerrero³

et al. 2022

WJGS

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“…Post-operative follow-up was previously reported [ 19 , 25 ]. In brief, patients underwent physical examination, laboratory tests (here including oncological markers), and transabdominal ultrasound every 3 months for the first 2 years after PD.…”

Section: Methodsmentioning

confidence: 99%

The impact of the histological classification of ampullary carcinomas on long-term outcomes after pancreaticoduodenectomy: a single tertiary referral center evaluation

Quero

Laterza

Fiorillo

et al. 2022

Langenbecks Arch Surg

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Purpose Ampullary carcinomas (ACs) are classified as pancreatobiliary (Pb-AC), intestinal (Int-AC), or mixed (Mixed-AC). The influencing role of AC subtypes on long-term outcomes is still matter of debate. Aim of this study is to evaluate the prognostic role of the three histological variants on the overall (OS) and disease-free survival (DFS) after pancreaticoduodenectomy(PD). Methods All PDs for AC between 2004 and 2020 were included. Patients were classified according to the histological feature in Pb-AC, Int-AC, and Mixed-AC. Five-year OS and DFS were compared among the subtypes. Additionally, the prognostic role of the histological classification on OS and DFS was evaluated. Results Fifty-six (48.7%) Pb-ACs, 53 (46.1%) Int-ACs, and 6 (5.2%) Mixed-ACs were evaluated. A poorer 5-year OS was evidenced for the Pb-AC group (54.1%) as compared to the Int-AC cohort (80.7%) (p = 0.03), but similar to the Mixed-AC population (33%) (p = 0.45). Pb-AC presented a worse 5-year DFS (42.3%) in comparison to the Int-AC (74.8%) (p = 0.002), while no difference was evidenced in comparison to the Mixed-AC (16.7%) (p = 0.51). At the multivariate analysis, the Pb-/Mixed-AC histotype was recognized as negative prognostic factor for both OS (OR: 2.29, CI: 1.05–4.98; p = 0.04) and DFS (OR: 2.17, CI: 1–4.33; p = 0.02). Conclusion Histological subtypes of AC play a relevant role in long-term outcomes after PD. Pb-ACs and Mixed-ACs show a more aggressive tumor biology and a consequent worse survival as compared to the Int-AC subtype.

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“…pancreatoduodenales inferiores, der 1. Jejunalarterie und der A. mesenterica superior [47]. Um diese Lymphknoten im Rahmen der Lymphadenektomie mit zu erfassen, bedarf es einer En-bloc-Dissektion des Mesopankreas mit Absetzung der Aa.…”

Section: Chirurgische Therapie Des Ampullenkarzinomsunclassified

“…Auch wenn sich eine erweiterte Lymphadenektomie unter Mitnahme der Lymphknoten um den Truncus coeliacus, linksseitig der A. mesenterica superior, der A. splenica und der A. gastrica sinistra, nicht vorteilhaft auf das Langzeitüberleben auswirkt, besteht Konsens zur Resektion aller suspekt erscheinenden, lokalen Lymphknoten zur Sicherstellung einer adäquaten Einschätzung des regionären Lymphknotenstatus [48]. Der mesopankreatischen Dissektion konnte beim Ampullenkarzinom im Rahmen der Pankreatoduodenektomie eine Verbesserung des Langzeitüberlebens und einer Verminderung der Rezidivrate zugeschrieben werden [47,49]. Eine Infiltration des Pankreas, Lymphknoteninvasion, eine geringe Differenzierung, Tumorgröße und lokal fortgeschrittene Stadien (T3 b und T4) stellen Risikofaktoren für das Auftreten von Rezidiven und Metastasen dar [50].…”

Section: Chirurgische Therapie Des Ampullenkarzinomsunclassified

Das Ampullenkarzinom – prognostische und therapeutische Unterschiede zum duktalen Adenokarzinom des Pankreas

2022

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ZusammenfassungDas Ampullenkarzinom stellt eine seltene, jedoch in seiner Inzidenz steigende Entität gastrointestinaler Tumoren dar. Aufgrund der anatomischen Lokalisation führt es vergleichsweise früh im Erkrankungsprozess zu einer biliären Gangobstruktion, wodurch eine schnellere Diagnosestellung erleichtert und eine bessere Prognose bedingt werden. Adenome der Ampulla hepatopancreatica und der Papilla duodeni major stellen Vorläuferläsionen des Ampullenkarzinoms dar und besitzen ein 30–40%iges Risiko zur malignen Transformation. Diese Entartungstendenz begründet die Notwendigkeit zur vollständigen/kompletten Abtragung im Rahmen der endoskopischen Therapie. Der Erfolg der endoskopischen Papillektomie wird durch eine Ausdehnung des Befundes in den Pankreashauptgang oder Ductus choledochus erschwert. Endoskopisch nicht sanierbare Adenome und Ampullenkarzinome stellen Indikationen für chirurgische Therapieverfahren dar. Grundsätzlich sollte für benigne Befunde die transduodenale Papillenresektion bervorzugt werden, für maligne Befunde stellt die Pankreaskopfresektion mit systematischer Lymphadenektomie und Level-II-Dissektion des Mesopankreas die onkologisch korrekte Operation dar. Prognostische Faktoren beim Ampullenkarzinom sind: der pankreatobiliäre Subtyp, eine Lymphknoteninfiltration und eine Perineuralscheideninvasion. Die Differenzierung in histopathologische Subtypen gewinnt zunehmend in der Indikationsstellung zur Systemtherapie an Bedeutung. Der Einsatz der neoadjuvanten und adjuvanten Therapie für das Ampullenkarzinom konnte bisher nicht klar definiert werden. Jedoch scheinen Patienten mit dem pankreatobiliären Subtyp oder anderen prognoselimitierenden Faktoren von einer adjuvanten Therapie zu profitieren. Zukünftige Studien werden zur zielgerichteten Therapiefestlegung benötigt.

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The role of mesopancreas excision for ampullary carcinomas: a single center propensity-score matched analysis

Cited by 12 publications

References 34 publications

Survival after curative pancreaticoduodenectomy for ampullary adenocarcinoma in a South American population: A retrospective cohort study

Survival after curative pancreaticoduodenectomy for ampullary adenocarcinoma in a South American population: A retrospective cohort study

The impact of the histological classification of ampullary carcinomas on long-term outcomes after pancreaticoduodenectomy: a single tertiary referral center evaluation

Das Ampullenkarzinom – prognostische und therapeutische Unterschiede zum duktalen Adenokarzinom des Pankreas

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