Transduodenal ampullectomy provides a less invasive technique to cure early ampullary cancer

Abstract

BackgroundThe aim of this study was to evaluate the clinical efficiency of transduodenal ampullectomy (TDA) compared to conventional pancreatoduodenectomy (PD) in patients with early ampullary cancers.MethodsWe carried out a retrospective study by reviewing the medical records of 43 patients with early ampullary cancer who underwent either TDA or PD from January 2001 to December 2014. TDA and PD were performed on 22 patients and 21 patients, respectively. Clinical data, perioperative clinical outcomes and prognosis were evaluated. The median follow-up was 75 (range, 38–143) months.ResultsThe sensitivity of intraoperative frozen resection was 100 % (4/4) and 94.9 % (37/39) in patients with pTis and pT1 tumors compared to final histologic diagnoses. The 5-year survival rate of patients with early ampullary cancer was 77.3 % in TDA group and 75.9 % in PD group (P = 0.927). Patients with lymph node metastasis presented a shorter 5-year survival rate (P = 0.014). TDA was associated with lower surgical morbidity (P = 0.033), estimated blood loss (P = 0.002), medical cost (P = 0.028) compared to PD. No pancreatic fistula and surgical mortality occurred in TDA group.ConclusionsTDA could produce satisfactory clinical efficiency in patients fulfilled the following criteria simultaneously: pTis or pT1 stage, tumor size ≤ 2 cm, without lymph node metastasis. To achieve favorable outcomes, intraoperative frozen section examinations should be reliable and resection margins should be negative.

A Comparison of Clinical Outcomes between Endoscopic Resection and Surgical Resection in Ampullary Tumors

“…However, the results of the new trials have limitations due to the small number of patients. The different guidelines for various lesions were applied in eligible studies, and the therapeutic effects of ER and SR can be variable according to the reports [ 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 ]. In the current study, the overall information for the therapeutic effect and complication of ER was obtained through a meta-analysis.…”

Transduodenal ampullectomy for ampullary tumors – single center experience of consecutive 26 patients

“…Several studies have suggested PD as the choice of treatment for ampullary cancer owing to the risk of recurrence and chances of lymph node positivity [ 17 18 ]. On the other hand, in several other studies, TDA could be performed for Tis and T1 ampullary neoplasms without lymph node metastasis, showing similar 5-year survival and recurrence rates but lower surgical morbidity, estimated blood loss, intraoperative transfusion, and operation time than with PD [ 19 20 ]. The feasibility of TDA for ampullary cancer is remains controversial.…”

Endoscopic and surgical ampullectomy for non-invasive ampullary tumors: Short-term outcomes

“…No further assessment is recommended for patients without invasive cancer and macroscopic features of malignancy (6). Patients who do not meet these two criteria should undergo a Computed Tomography scan (CT-scan) to exclude a metastasize disease, which will indicate the necessity of a palliative care.…”

“…Although pancreaticoduodenectomy (PD) has been evidenced as the treatment of choice for invasive ampullary tumors (1,3), its high morbidity and mortality may not be justified for non-invasive tumors. (4)(5)(6). Indeed, less invasive techniques such as surgical ampullectomy (SA) and endoscopic ampullectomy (EA) have been acknowledged as appropriate approaches for this indication (7)(8)(9)(10)(11).…”