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Can endoscopic papillectomy be curative for early ampullary adenocarcinoma of the ampulla of Vater?

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Abstract

Background

The therapeutic role of endoscopic papillectomy (EP) for early ampullary cancer (AC) is still controversial. The aim of the present study was to evaluate the curative potential of EP for early AC and to identify predictors of lymph node metastases (LNMs).

Methods

We retrospectively reviewed 173 patients who were prospectively included in a database and who underwent EP between 1999 and 2013. Adenocarcinoma was present in 28 resected specimens. An additional surgery was proposed in cases of duodenal submucosal infiltration, duct ingrowth, R1 resection or lymphovascular invasion. Clinicopathological information and outcomes were collected, and predictors of LNMs were evaluated.

Results

Duodenal submucosal invasion was present in 16/28 cases and LNMs, in 9/28 cases. ACs of the biliopancreatic subtype were smaller (NS); 100 % had submucosal invasion, and 71 % had LNMs. Smaller tumour size, biliopancreatic subtype and submucosal invasion were significantly correlated with LNMs (p < 0.028, p < 0.028 and p < 0.014). Predictive factors of LNMs in the multivariate analysis were submucosal invasion and tumour size (OR 0.032, p < 0.023 and OR 0.711, p < 0.035). EP was curative in 100 % of cancers with R0 resection and no evidence of submucosal or lymphovascular invasion.

Conclusion

EP may be curative for patients with AC limited to the duodenal mucosa or the sphincter of Oddi without lymphovascular invasion. Due to the presence of more invasive stages at diagnosis, EP may not be curative for ACs of the biliopancreatic subtype. The significance of tumour size is limited by other confounders, such as the histological subtype.

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Authors and Affiliations

  1. Department of Gastroenterology, Ramsay Générale de Santé, Hôpital Privé Jean Mermoz, 55 avenue Jean Mermoz, 69008, Lyon, France

    María-Victoria Alvarez-Sanchez, Inés Oria, Olivia B. Luna, Rodica Gincul, Christine Lefort, Fabien Fumex, Vincent Lepilliez & Bertrand Napoléon

  2. Department of Gastroenterology, Complejo Hospitalario de Pontevedra, Pontevedra, Spain

    María-Victoria Alvarez-Sanchez

  3. Department of Gastroenterology, Hospital Italiano, Buenos Aires, Argentina

    Inés Oria

  4. Clinica Echoendo, Rio de Janeiro, Brazil

    Olivia B. Luna

  5. Office of Pathology, 41, Allée des Cyprès, Limonest, France

    Jean Pialat

  6. Department of Gastroenterology, Hospices Civils de Lyon, Hôpital Edouard Herriot, Lyon, France

    Rodica Gincul

  7. Department of Digestive Surgery, Ramsay Générale de Santé, Hôpital Privé Jean Mermoz, Lyon, France

    Raphael Bourdariat

  8. Department of Pathology, Hospices Civils de Lyon, Hôpital Edouard Herriot, Lyon, France

    Jean Yves Scoazec

  9. Instituto de Investigación Sanitaria Galicia Sur (IISGS), Pontevedra, Spain

    Angel Salgado-Barreira

  10. Centre Léon Bérard, Department of Biopathology, Lyon, France

    Anne Isabelle Lemaistre

Authors
  1. María-Victoria Alvarez-Sanchez
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  2. Inés Oria
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  3. Olivia B. Luna
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  4. Jean Pialat
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  8. Fabien Fumex
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  9. Vincent Lepilliez
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  10. Jean Yves Scoazec
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  12. Anne Isabelle Lemaistre
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  13. Bertrand Napoléon
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Corresponding author

Correspondence to Bertrand Napoléon.

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Disclosures

Drs. Alvarez-Sanchez, Oria, Luna, Pialat, Gincul, Lefort, Bourdariat, Fumex, Lepilliez, Scoazec, Salgado-Barreira, Lemeistre and Napoleon have no conflicts of interest or financial ties to disclose.

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Alvarez-Sanchez, MV., Oria, I., Luna, O.B. et al. Can endoscopic papillectomy be curative for early ampullary adenocarcinoma of the ampulla of Vater?. Surg Endosc 31, 1564–1572 (2017). https://doi.org/10.1007/s00464-016-5141-1

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  • DOI: https://doi.org/10.1007/s00464-016-5141-1

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