Choice of surgical procedures for patients with stage T1 carcinoma of the papilla of Vater: a retrospective study

Abstract

Background: Given the high incidence of complications after pancreaticoduodenectomy (PD), local resection is being applied to cure stage T1 carcinoma of the papilla of Vater (CPV). In the present study, risk factors related to nodal involvement and prognosis were evaluated so as to enable the choice of optimal surgical procedure for patients with stage T1 CPV.Methods: A retrospective study of 94 consecutive patients with CPV who underwent PD in our center from 2013 to 2018 was conducted.Results: A total of 44 patients (46.8%; 44 of 94) had lymph node metastasis. T1 tumors were subdivided into layer I (the mucosa) and layer II (the submucosa) based on anatomical stratification, and lymph node metastasis did not occur in patients with layer I invasion. The nodal metastasis rate was up to 25% (6 of 24) in patients with layer II invasion. The gross appearance, depth of duodenal invasion, pT stage and perineural invasion were risk factors related to nodal involvement. Only the depth of duodenal invasion remained a significant independent factor (P=0.003). Multivariate Cox analysis indicated that depth of duodenal invasion (P=0.001), nodal involvement (P<0.001), and venous invasion (P<0.001) were independent prognostic factors. The depth of duodenal invasion is the only independent risk factor related to nodal involvement and prognosis. Conclusions:The optimal surgical option should be PD with radical lymphadenectomy for patients with stage T1 CPV; only patients with duodenal invasion limited to the mucosa are suitable for local resection. A modified T category needs to be proposed based on the detailed depth of duodenal invasion.