Outcomes of endoscopic papillectomy of ampullary carcinoma and factors affecting additional surgery
Yoshihisa Takada
Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
Search for more papers by this authorCorresponding Author
Takuya Ishikawa
Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
Correspondence
Takuya Ishikawa Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, 65, Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8560, Japan.
Email: [email protected]
Search for more papers by this authorKentaro Yamao
Department of Endoscopy, Nagoya University Hospital, Nagoya, Japan
Search for more papers by this authorYasuyuki Mizutani
Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
Search for more papers by this authorTadashi Iida
Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
Search for more papers by this authorKota Uetsuki
Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
Search for more papers by this authorNoriaki Gibo
Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
Search for more papers by this authorEizaburo Ohno
Department of Gastroenterology and Hepatology, Fujita Health University, Toyoake, Japan
Search for more papers by this authorHiroki Kawashima
Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
Search for more papers by this authorYoshihisa Takada
Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
Search for more papers by this authorCorresponding Author
Takuya Ishikawa
Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
Correspondence
Takuya Ishikawa Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, 65, Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8560, Japan.
Email: [email protected]
Search for more papers by this authorKentaro Yamao
Department of Endoscopy, Nagoya University Hospital, Nagoya, Japan
Search for more papers by this authorYasuyuki Mizutani
Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
Search for more papers by this authorTadashi Iida
Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
Search for more papers by this authorKota Uetsuki
Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
Search for more papers by this authorNoriaki Gibo
Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
Search for more papers by this authorEizaburo Ohno
Department of Gastroenterology and Hepatology, Fujita Health University, Toyoake, Japan
Search for more papers by this authorHiroki Kawashima
Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
Search for more papers by this authorAbstract
Background/Purpose
Data on the prognosis of endoscopic papillectomy (EP) for ampullary carcinoma (AC) is limited; therefore, we aimed to identify the factors associated with endoscopically controlled AC.
Methods
Between January 2003 and October 2022, 75 patients underwent EP for ampullary tumors and were diagnosed with AC based on the pathological features of the resected tissue. The factors associated with additional surgery after EP were also evaluated.
Results
A total of 67 patients had ACs ranging from carcinoma in situ to tumors limited to the mucosa (M group), and eight patients had ACs ranging from those limited to the sphincter of Oddi to those invading the duodenal muscularis propria (OD group). The 3-year endoscopic tumor control (condition not requiring additional surgery) rates in the M and OD groups were 90.8% and 84.6% (p = .033), respectively. In the M group, the presence of tumor components in the resection margins was the only significant factor associated with additional surgeries (p = .010) in the univariate analysis. The 3-year endoscopic tumor control rates were 100% for negative and uncertain resection margins and 76.6% for positive margins (p = .009).
Conclusions
If the AC is confined to the mucosa and the resection margins are negative or uncertain, the tumor can be well-controlled endoscopically.
CONFLICT OF INTEREST STATEMENT
All authors declare no conflict of interests for this article.
REFERENCES
- 1 Surveillance, Epidemiology, and End Results Program. https://seer.cancer.gov/. Accessed 13 Sep 2021
- 2Martin JA, Haber GB. Ampullary adenoma: clinical manifestations, diagnosis, and treatment. Gastrointest Endosc Clin N Am. 2003; 13(4): 649–669. https://doi.org/10.1016/S1052-5157(03)00101-6
- 3Spadaccini M, Fugazza A, Frazzoni L, Leo MD, Auriemma F, Carrara S, et al. Endoscopic papillectomy for neoplastic ampullary lesions: a systematic review with pooled analysis. United Eur Gastroenterol J. 2020; 8(1): 44–51. https://doi.org/10.1177/2050640619868367
- 4Itoi T, Ryozawa S, Katanuma A, Kawashima H, Iwasaki E, Hashimoto S, et al. Clinical practice guidelines for endoscopic papillectomy. Dig Endosc. 2022; 9: 394–411. https://doi.org/10.1111/DEN.14233
10.1111/den.14233 Google Scholar
- 5Lee HS, Jang JS, Lee S, Yeon MH, Kim KB, Park JG, et al. Diagnostic accuracy of the initial endoscopy for ampullary tumors. Clin Endosc. 2015; 48(3): 239–246. https://doi.org/10.5946/CE.2015.48.3.239
- 6Ito K, Fujita N, Noda Y, Kobayashi G, Horaguchi J, Takasawa O, et al. Preoperative evaluation of ampullary neoplasm with EUS and transpapillary intraductal US: a prospective and histopathologically controlled study. Gastrointest Endosc. 2007; 66(4): 740–747. https://doi.org/10.1016/J.GIE.2007.03.1081
- 7Yamamoto K, Itoi T, Nagata N, Sofuni A, Tsuchiya T, Ishii K, et al. Novel method for evaluating the indication for endoscopic papillectomy in patients with ampullary adenocarcinoma. Sci Rep. 2021; 11(1): 600. https://doi.org/10.1038/S41598-020-79836-4
- 8Tanaka H, Kawashima H, Ohno E, Ishikawa T, Iida T, Ishikawa E, et al. Immunohistochemical staining for IMP3 in patients with duodenal papilla tumors: assessment of the potential for diagnosing endoscopic resectability and predicting prognosis. BMC Gastroenterol. 2021; 21(1): 224. https://doi.org/10.1186/S12876-021-01811-8
- 9Yamamoto K, Itoi T, Sofuni A, Tsuchiya T, Tanaka R, Tonozuka R, et al. Expanding the indication of endoscopic papillectomy for T1a ampullary carcinoma. Dig Endosc. 2019; 31(2): 188–196. https://doi.org/10.1111/DEN.13265
- 10Fritzsche JA, Fockens P, Barthet M, Bruno MJ, Carr-Locke DL, Costamagna G, et al. Expert consensus on endoscopic papillectomy using a Delphi process. Gastrointest Endosc. 2021; 94(4): 760–773.e18. https://doi.org/10.1016/J.GIE.2021.04.009
- 11Vanbiervliet G, Strijker M, Arvanitakis M, Aelvoet A, Arnelo U, Beyna T, et al. Endoscopic management of ampullary tumors: European Society of Gastrointestinal Endoscopy (ESGE) guideline. Endoscopy. 2021; 53(4): 429–448. https://doi.org/10.1055/A-1397-3198/ID/JR20605-17
- 12Kawashima H, Ohno E, Ishikawa T, Iida T, Tanaka H, Furukawa K, et al. Endoscopic papillectomy for ampullary adenoma and early adenocarcinoma: analysis of factors related to treatment outcome and long-term prognosis. Dig Endosc. 2021; 33(5): 858–869. https://doi.org/10.1111/DEN.13881
- 13Itoh A, Goto H, Naitoh Y, Hirooka Y, Furukawa T, Hayakawa T. Intraductal ultrasonography in diagnosing tumor extension of cancer of the papilla of Vater. Gastrointest Endosc. 1997; 45(3): 251–260. https://doi.org/10.1016/S0016-5107(97)70267-0
- 14Takada Y, Kawashima H, Ohno E, Ishikawa T, Mizutani Y, Iida T, et al. The impact of the age-adjusted Charlson comorbidity index as a prognostic factor for endoscopic papillectomy in ampullary tumors. J Gastroenterol. 2022; 57(3): 199–207. https://doi.org/10.1007/S00535-022-01853-Z
- 15Kaiser A, Jurowich C, Schönekäs H, Gebhardt C, Wünsch PH. The adenoma-carcinoma sequence applies to epithelial tumours of the papilla of Vater. Z Gastroenterol. 2002; 40(11): 913–920. https://doi.org/10.1055/S-2002-35414
- 16Menzel J, Poremba C, Dietl KH, Böcker W, Domschke W. Tumors of the papilla of Vater--inadequate diagnostic impact of endoscopic forceps biopsies taken prior to and following sphincterotomy. Ann Oncol. 1999; 10(10): 1227–1231. https://doi.org/10.1023/A:1008368807817
- 17Haraldsson E, Halimi A, Rangelova E, Valente R, Löhr JM, Arnelo U. Adenomatous neoplasia in the papilla of Vater endoscopic and/or surgical resection? Surg Endosc. 2022; 36(4): 2401–2411. https://doi.org/10.1007/S00464-021-08521-Y
- 18You D, Heo J, Choi S, Choi D, Jang K-T. Pathologic T1 subclassification of ampullary carcinoma with Perisphincteric or duodenal submucosal invasion: is it T1b? Arch Pathol Lab Med. 2014; 138(8): 1072–1076. https://doi.org/10.5858/ARPA.2013-0324-OA
- 19Kohga A, Yamamoto Y, Sano S, Sugiura T, Okamura Y, Ito T, et al. Surgical strategy for t1 duodenal or ampullary carcinoma according to the depth of tumor invasion. Anticancer Res. 2017; 37(9): 5277–5283. https://doi.org/10.21873/anticanres.11953
- 20Hwang JS, So H, Oh D, Song TJ, Park DH, Seo DW, et al. Long-term outcomes of endoscopic papillectomy for early-stage cancer in duodenal ampullary adenoma: comparison to surgical treatment. J Gastroenterol Hepatol. 2021; 36(8): 2315–2323. https://doi.org/10.1111/JGH.15462
- 21Woo SM, Ryu JK, Lee SH, Lee WJ, Hwang JH, Yoo JW, et al. Feasibility of endoscopic papillectomy in early stage ampulla of Vater cancer. J Gastroenterol Hepatol. 2009; 24(1): 120–124. https://doi.org/10.1111/J.1440-1746.2008.05578.X
- 22Askew J, Connor S. Review of the investigation and surgical management of resectable ampullary adenocarcinoma. HPB (Oxford). 2013; 15(11): 829–838. https://doi.org/10.1111/HPB.12038
- 23Ito K, Fujita N, Noda Y, Kobayashi G, Obana T, Horaguchi J, et al. Impact of technical modification of endoscopic papillectomy for ampullary neoplasm on the occurrence of complications. Dig Endosc. 2012; 24(1): 30–35. https://doi.org/10.1111/J.1443-1661.2011.01161.X
- 24Hyun JJ, Lee TH, Park JS, Han JH, Jeong S, Park SM, et al. A prospective multicenter study of submucosal injection to improve endoscopic snare papillectomy for ampullary adenoma. Gastrointest Endosc. 2017; 85(4): 746–755. https://doi.org/10.1016/J.GIE.2016.08.013
- 25Takahara N, Tsuji Y, Nakai Y, Suzuki Y, Inokuma A, Kanai S, et al. A novel technique of endoscopic papillectomy with hybrid endoscopic submucosal dissection for ampullary tumors: a proof-of-concept study (with video). J Clin Med. 2020; 9(8): 1–9. https://doi.org/10.3390/JCM9082671
- 26Pérez-Cuadrado-Robles E, Piessevaux H, Moreels TG, Yeung R, Aouattah T, Komuta M, et al. Combined excision and ablation of ampullary tumors with biliary or pancreatic intraductal extension is effective even in malignant neoplasms. United Eur Gastroenterol J. 2019; 7(3): 369–376. https://doi.org/10.1177/2050640618817215
- 27Xia MX, Shi ZM, Xing L, Gao DJ, Ye X, Wang TT, et al. Endoscopic radiofrequency ablation may improve overall survival in patients with inoperable ampullary carcinoma. Dig Endosc. 2022; 34(3): 587–595. https://doi.org/10.1111/DEN.14078
- 28Muro S, Kato H, Matsumi A, Ishihara Y, Saragai Y, Yabe S, et al. The long-term outcomes of endoscopic papillectomy and Management of Cases of incomplete resection: a single-center study. J Gastrointest Surg. 2021; 25(5): 1247–1252. https://doi.org/10.1007/S11605-020-04532-7
- 29Sakai A, Tsujimae M, Masuda A, Iemoto T, Ashina S, Yamakawa K, et al. Clinical outcomes of ampullary neoplasms in resected margin positive or uncertain cases after endoscopic papillectomy. World J Gastroenterol. 2019; 25(11): 1387–1397. https://doi.org/10.3748/WJG.V25.I11.1387
- 30Li S, Wang Z, Cai F, Linghu E, Sun G, Wang X, et al. New experience of endoscopic papillectomy for ampullary neoplasms. Surg Endosc. 2019; 33(2): 612–619. https://doi.org/10.1007/S00464-018-6577-2/TABLES/9
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