Endoscopic papillectomy versus surgical ampullectomy for adenomas and early cancers of the papilla: a retrospective Pancreas2000/European Pancreatic Club analysis

Hollenbach M, Heise C, Abou-Ali E, Gulla A, Auriemma F, Soares K, Leung G, Schattner MA, Jarnagin WR, Wang T, Caillol F, Giovannini M, Dahel Y, Hackert T, Paik WH, Zerbi A, Nappo G, Napoleon B, Arnelo U, Haraldsson E, Halimi A, Waldthaler A, Will U, Saadeh R, Masaryk V, van der Wiel SE, Bruno MJ, Perez-Cuadrado-Robles E, Deprez P, Sauvanet A, Bolm L, Keck T, Souche R, Fabre JM, Musquer N, Kähler G, Seyfried S, Petrone MC, Mariani A, Zaccari P, Belfiori G, Crippa S, Falconi M, Partelli S, Yilmaz B, Demir IE, Ceyhan GO, Satoi S, Regimbeau JM, Gagniére J, Repici A, Anderloni A, Vollmer C, Casciani F, Chiaro MD, Oba A, Schulick RD, Berger A, Maggino L, Salvia R, Schemmer P, Wichmann D, Inoue Y, Dinis-Ribeiro M, Laranjo A, Libanio D, Kleemann T, Sandru V, Ilie M, Ahola R, Laukkarinen J, Schumacher B, Albers D, Gonçalves TC, Barbier L, Salamé E, Weismüller TJ, Heling D, Alves A, Karam E, Regenet N, Dugic A, Mühldorfer S, Truant S, Caca K, Meier B, Miutescu BP, Tantau M, Birnbaum D, Miksch RC, Wedi E, Salzmann K, Bruzzi M, Lupinacci RM, David P, De Ponthaud C, Schmidt A, Regnér S, Gaujoux S

Publication Type: Journal article

Journal

DOI: 10.1136/gutjnl-2022-327996

Abstract

Objective: Ampullary neoplastic lesions can be resected by endoscopic papillectomy (EP) or transduodenal surgical ampullectomy (TSA) while pancreaticoduodenectomy is reserved for more advanced lesions. We present the largest retrospective comparative study analysing EP and TSA. Design: Of all patients in the database, lesions with prior interventions, benign histology advanced malignancy (T2 and more), patients with hereditary syndromes and those undergoing pancreatoduodenectomy were excluded. All remaining cases as well as a subgroup of them, after propensity-score matching (nearest-neighbour-method) based on age, gender, anthropometrics, comorbidities, size and histological subtype, were analysed. The median follow-up was 21 months (IQR 10-47) after the primary intervention. Primary outcomes were rates of complete resection (R0) and complications. Groups were compared by Fisher's exact or χ² test, Mann-Whitney-U-test and log-rank test for survival. Results: Of 1673 patients in the database, 1422 underwent EP and 251 TSA. Of them, 23.2% were excluded for missing or inconclusive data and 19.8% of patients for prior interventions or hereditary syndromes. Final histology showed in 24.2% of EP and 14.8% of TSA patients a histology other than adenoma or adenocarcinoma while advanced cancers were recorded in 10.9% of EP and 36.6% of TSA patients. Finally, 569 EP and 63 TSA were included in the overall analysis, with a higher rate of more advanced cases and higher R0 resection rates in the TSA groups (90.5% vs 73.1%; p<0.01), with additional ablation in the EP group in 14.4%. Severe adverse event rates were 3.2% (TSA) vs 1.9% (EP). Recurrence after histological R0 resection was 16% (EP) vs 3.2% (TSA; p=0.01), and additional therapy for R1 resection was applied in 67% of the 159 cases. Propensity-score-based matching identified 62 pairs of EP/TSA patients with comparable baseline patient and lesion characteristics. The initial R0-rate was 72.6% (EP) compared with 90.3% (TSA, p=0.02) with recurrences found in 8% (EP) vs 3.2% (TSA; p=0.07); reinterventions were more frequent in the EP group. Overall survival was comparable. Conclusions: The rate of patients with poor indications due to non-neoplastic disease or advanced cancer is still high for both EP and TSA; multiple retreatments were necessary for EP. Although EP can be considered an appropriate primary therapy for certain ampullary adenomas, case selection for both therapies (especially with regard to the best step-up approach) should be studied further.

Authors with CRIS profile

Involved external institutions

University of Verona / Università degli Studi di Verona Italy (IT) Karl-Franzens-Universität Graz Austria (AT) Universitätsklinikum Tübingen Germany (DE) The Cancer Institute Hospital / がん研有明病院 Japan (JP) Instituto Português de Oncologia do Porto FG, EPE (IPO-Porto) Portugal (PT) Groupe Hospitalier Diaconesses Croix Saint-Simon (DCSS) France (FR) Memorial Sloan Kettering Cancer Center United States (USA) (US) Institute Paoli-Calmettes France (FR) Karolinska Institute Sweden (SE) Karolinska University Hospital / Karolinska Universitetssjukhuset Sweden (SE) SRH Wald-Klinikum Gera Germany (DE) Ruprecht-Karls-Universität Heidelberg Germany (DE) Seoul National University (SNU) / 서울대학교 Korea, Republic of (KR) Humanitas University Italy (IT) Università Vita-Salute San Raffaele (UniSR) Italy (IT) Policlinico San Matteo Pavia Fondazione IRCCS Italy (IT) Universitätsklinikum Gießen und Marburg (UKGM) Germany (DE) Carl-Thiem-Klinikum Germany (DE) Martin-Luther-Universität Halle-Wittenberg (MLU) Germany (DE) Université Sorbonne Paris Cité France (FR) George Washington University (GWU) United States (USA) (US) Carol Davila University of Medicine and Pharmacy / Universitatea de Medicină și Farmacie „Carol Davila” (UMF București) Romania (RO) University of Tampere (UTA) / Tampereen yliopisto (Tay) Finland (FI) Humanitas Mater Domini Italy (IT) Contilia GmbH Germany (DE) University of Pennsylvania (UPenn) United States (USA) (US) Centre Hospitalier Régional Universitaire de Tours France (FR) Erasmus University Medical Center (MC) Netherlands (NL) Georges Pompidou European Hospital / Hôpital Européen Georges-Pompidou (HEGP) France (FR) Vivantes - Netzwerk für Gesundheit GmbH Germany (DE) Universitätsklinikum Bonn Germany (DE) Cliniques universitaires Saint-Luc (CHU St-Luc) Belgium (BE) Beaujon Hospital / Hôpital Beaujon France (FR) Universitätsklinikum Schleswig-Holstein (UKSH) Germany (DE) Centre Hospitalier Universitaire de Montpellier (CHU/CHRU MTP) France (FR) Santé Atlantique à Nantes France (FR) Normandy University / Normandie Université France (FR) Nantes University Hospital / Centre hospitalier universitaire de Nantes (CHU) France (FR) Centre Hospitalier Régional Universitaire de Lille (CHRU de Lille) France (FR) Victor Babes University of Medicine and Pharmacy Romania (RO) Institutul Regional de Gastroenterologie Prof. Dr. Octavian Fodor Romania (RO) Aix-Marseille University / Aix-Marseille Université France (FR) Ludwig-Maximilians-Universität (LMU) Germany (DE) Sana Kliniken AG Germany (DE) Georg-August-Universität Göttingen Germany (DE) Klinikum rechts der Isar Germany (DE) Acıbadem Üniversitesi Turkey (TR) Pitié-Salpêtrière University Hospital / Hôpital universitaire Pitié-Salpêtrière France (FR) Universitätsklinikum Freiburg Germany (DE) Lund University / Lunds universitet Sweden (SE) Kansai Medical University Japan (JP) Centre Hospitalier Universitaire Amiens-Picardie (CHU Amiens-Picardie) France (FR) CHU Clermont-Ferrand France (FR) University of Colorado Anschutz Medical Campus United States (USA) (US) Centre Hospitalier Universitaire de Bordeaux / CHU Bordeaux France (FR)

How to cite

APA:

Hollenbach, M., Heise, C., Abou-Ali, E., Gulla, A., Auriemma, F., Soares, K.,... Gaujoux, S. (2024). Endoscopic papillectomy versus surgical ampullectomy for adenomas and early cancers of the papilla: a retrospective Pancreas2000/European Pancreatic Club analysis. Gut. https://doi.org/10.1136/gutjnl-2022-327996

MLA:

Hollenbach, Marcus, et al. "Endoscopic papillectomy versus surgical ampullectomy for adenomas and early cancers of the papilla: a retrospective Pancreas2000/European Pancreatic Club analysis." Gut (2024).

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