Local excision as a treatment for tumors of ampulla of Vater

Demetriades, H.; Zacharakis, Emmanouil; Kirou, Ioanna E.; Pramateftakis, Manousos-Georgios; Sapidis, Nikolaos; Kanellos, Ioannis; Betsis, D.

doi:10.1186/1477-7819-4-14

Cited by 40 publications

(35 citation statements)

References 34 publications

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“… 8 9 10 Recently, local resection or endoscopic resection of the ampulla alone was done for patients at early stages or with a high surgical risk, but the prognosis is a subject of controversy. 11 12 13 14 …”

Section: Introductionmentioning

confidence: 99%

Adenocarcinoma of the ampulla of Vater: predictors of survival and recurrence after curative radical resection

Kim

Choi

Kim

et al. 2011

Korean J Hepatobiliary Pancreat Surg

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Backgrounds/AimsBecause of low incidence rates, there have been few reports on the patterns of and risk factors for recurrence after curative resection of the ampulla of Vater (AoV) cancer. The aim of this study was to characterize patterns of recurrence and to evaluate risk factors affecting survival rates and recurrence after curative resection.MethodsMedical records of 181 patients who had undergone pancreaticoduodenectomy with curative intent for AoV adenocarcinoma between December 1994 and March 2010 at Samsung Medical Center were retrospectively reviewed. Factors influencing on overall survival rate, recurrence rates, and recurrence patterns were analyzed.ResultsLymph node metastases and high preoperative serum carcinoembryonic antigen (CEA) level >5 ng/ml were identified as independent factors affecting overall survival (p=0.006, p<0.001, respectively). Among the 181 patients, 69 developed local or distant recurrence within 3 years after curative resection. Lymph node metastasis, preoperative serum CEA level >5 ng/ml, and total bilirubin level >1.5 mg/dl were identified as independent prognostic factors of recurrence after curative resection (p=0.008, p<0.001, p=0.003, respectively).ConclusionsAoV adenocarcinoma has a better prognosis than other periampullary carcinomas, but still has a high recurrence rate, especially during the first three years after curative radical resection. Therefore, careful follow-up is needed during the first 3 years, especially for the higher risk group. Further study of adjuvant therapy to decrease recurrence after curative resection is now warranted.

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Section: Introductionmentioning

confidence: 99%

Adenocarcinoma of the ampulla of Vater: predictors of survival and recurrence after curative radical resection

Kim

Choi

Kim

et al. 2011

Korean J Hepatobiliary Pancreat Surg

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“…More recently, many other series have reported low morbidity and mortality with endoscopic therapy (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19). However, the role of endoscopic ampullectomy remains controversial and it is generally performed only in reference centers with expertise in interventional endoscopy.…”

Section: Endoscopic Ampullectomymentioning

confidence: 99%

“…Endoscopic ampullectomy may be considered in patients with smaller lesions that do not contain invasive carcinoma, and in patients who are poor surgical candidates (4)(5)(6). Many series have reported low morbidity and mortality with endoscopic therapy (4,(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19). Limited data support particular techniques for endoscopic resection of ampullary tumors (e.g.…”

Section: Introductionmentioning

confidence: 99%

Endoscopic ampullectomy: A technical review

Espinel¹,

Pinedo²,

Ojeda³

et al. 2015

Rev Esp Enferm Dig

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Background and aim:This article provides a practical review to undertaking safe endoscopic ampullectomy and highlights some of the common difficulties with this technique as well as offering strategies to deal with these challenges.Methods: We conducted a review of studies regarding endoscopic ampullectomy for ampullary neoplasms with special focus on techniques.Results: Accurate preoperative diagnosis and staging of ampullary tumors is imperative for predicting prognosis and determining the most appropriate therapeutic approach. The optimal technique for endoscopic ampullectomy is dependent on the lesions size. En bloc resection is recommended for lesions confined to the papilla. There is no significant evidence to support the submucosal injection before ampullectomy. There is no consensus regarding the optimal current and power output for endoscopic ampulectomy. The benefits of a thermal adjunctive therapy remain controversial. A prophylactic pancreatic stent reduces the incidence and severity of pancreatitis post-ampullectomy.Conclusions: Endoscopic ampullectomy is a safe and efficacious therapeutic procedure for papillary adenomas in experienced endoscopist and it can avoid the need for surgical intervention.

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“…36 Demetriades et al 37 assume the local excision in early tumor stage (pT1) as adequate, not paying attention to lymph node involvement. On this line are also the findings from Beger et al 38 who showed that even the patients staged as pTis or pT1 without nodal involvement will benefit from the lymphadenectomy.…”

Section: Discussionmentioning

confidence: 99%