Long-term outcomes of endoscopic papillectomy for early-stage cancer in duodenal ampullary adenoma: Comparison to surgical treatment
- Authors
- Hwang, Jun Seong; So Hoonsub; Oh Dongwook; Song Tae Jun; Park Do Hyun; Seo Dong-Wan; Lee Sung Koo; Kim Myung-Hwan; Hong Seung-Mo; Yang Jungho; Lee Sang Soo
- Issue Date
- Aug-2021
- Publisher
- WILEY
- Keywords
- Adenocarcinoma; Duodenal ampullary tumor; Endoscopic papillectomy; Pancreaticoduodenectomy
- Citation
- JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, v.36, no.8, pp.2315 - 2323
- Indexed
- SCIE
SCOPUS
- Journal Title
- JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY
- Volume
- 36
- Number
- 8
- Start Page
- 2315
- End Page
- 2323
- URI
- https://scholarworks.bwise.kr/hanyang/handle/2021.sw.hanyang/190674
- DOI
- 10.1111/jgh.15462
- ISSN
- 0815-9319
- Abstract
- Background and Aim While recent evidences support endoscopic resection as curative in ampullary tumors with high-grade intraepithelial neoplasia, only small case series have reported endoscopic management of early-stage ampullary cancer; thus, radical surgery remains the only accepted treatment modality. We evaluated the long-term outcomes of early ampullary adenocarcinoma administered endoscopic management.,Methods We retrospectively reviewed electronic medical records of 715 patients undergoing endoscopic papillectomy (EP) in a single tertiary medical center in Korea in 2004-2016. We included patients incidentally diagnosed with early-stage adenocarcinoma (Tis and T1a, American Joint Committee on Cancer 8th edition) after EP and with >2 years of follow-up data and analyzed their demographics, histopathologic data, and clinical outcomes.,Results Among 70 total patients in the EP-alone (n = 42) and subsequent surgery (n = 28) groups, we observed no significant differences in demographics or tumor size (2.0 +/- 0.6 vs 1.9 +/- 0.5 cm, P = 0.532), histologic grade (P = 0.077), tumor extent (P = 1.000), lymphovascular invasion (2.4% vs 10.7%, P = 0.344), or complete resection rates (57.1% vs 57.1%, P = 1.000) between groups. Adenocarcinoma lesions were larger in the subsequent surgery group (0.7 +/- 0.5 vs 1.1 +/- 0.7 cm, P = 0.002). The EP-alone group received more additional ablative treatment (42.9% vs 14.3%, P = 0.024). The 5-year disease-free and cancer-free survival rates were 79.1% vs 87.4% (P = 0.111) and 93.5% versus 87.4% (P = 0.726), respectively, and did not differ significantly between groups.,Conclusions Endoscopic papillectomy followed by endoscopic surveillance showed long-term outcomes comparable with surgical resection for early ampullary cancer and maybe curable alternative to surgery for incidentally found early-stage ampullary cancer, especially in patients unfit for or refusing radical surgery.,
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