Transduodenal ampullectomy for ampullary tumors

Mansukhani, V.; Desai, Gunjan; Mouli, Sasi; Shirodkar, Keval; Shah, Rajiv; Palepu, Jagannath

doi:10.1007/s12664-016-0726-0

Cited by 10 publications

(9 citation statements)

References 10 publications

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“…After screening of titles and abstracts, 367 studies remained. Finally, 59 papers were eligible to be included into the meta-analysis after full-text evaluation (42 EA, 8 SA, 1 PD, 3 SA + PD, 4 EA + SA, 1 EA + PD; Figure 1 PRISMA chart) [ 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 ...…”

Section: Resultsmentioning

confidence: 99%

Systematic Review with Meta-Analysis: Endoscopic and Surgical Resection for Ampullary Lesions

Heise

Ali

Hasenclever

et al. 2020

JCM

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Ampullary lesions (ALs) can be treated by endoscopic (EA) or surgical ampullectomy (SA) or pancreaticoduodenectomy (PD). However, EA carries significant risk of incomplete resection while surgical interventions can lead to substantial morbidity. We performed a systematic review and meta-analysis for R0, adverse-events (AEs) and recurrence between EA, SA and PD. Electronic databases were searched from 1990 to 2018. Outcomes were calculated as pooled means using fixed and random-effects models and the Freeman-Tukey-Double-Arcsine-Proportion-model. We identified 59 independent studies. The pooled R0 rate was 76.6% (71.8–81.4%, I2 = 91.38%) for EA, 96.4% (93.6–99.2%, I2 = 37.8%) for SA and 98.9% (98.0–99.7%, I2 = 0%) for PD. AEs were 24.7% (19.8–29.6%, I2 = 86.4%), 28.3% (19.0–37.7%, I2 = 76.8%) and 44.7% (37.9–51.4%, I2 = 0%), respectively. Recurrences were registered in 13.0% (10.2–15.6%, I2 = 91.3%), 9.4% (4.8–14%, I2 = 57.3%) and 14.2% (9.5–18.9%, I2 = 0%). Differences between proportions were significant in R0 for EA compared to SA (p = 0.007) and PD (p = 0.022). AEs were statistically different only between EA and PD (p = 0.049) and recurrence showed no significance for EA/SA or EA/PD. Our data indicate an increased rate of complete resection in surgical interventions accompanied with a higher risk of complications. However, studies showed various sources of bias, limited quality of data and a significant heterogeneity, particularly in EA studies.

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Section: Resultsmentioning

confidence: 99%

Systematic Review with Meta-Analysis: Endoscopic and Surgical Resection for Ampullary Lesions

Heise

Ali

Hasenclever

et al. 2020

JCM

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“…Currently, although the approach of local tumor resection in the treatment of duodenal papillary tumors is attracting increasing attention from experts and scholars in China and other countries, there is still much debate over its indications and effects. Studies have demonstrated that the indications of local tumor resections include: Benign tumors at the duodenal papilla; pathologically confirmed malignant transformation of benign tumors; tumors with a diameter ≤ 2 cm, no infiltration, a margin with negative biopsy results, and no lymph node metastasis; well differentiated duodenal papillary cancer with a diameter < 1 cm and no lymph node metastasis (T 1-2 N 0 M 0 ); for older patients with multiple complications and higher surgical risks, local tumor resection can be adopted to improve the quality of life[ 3 , 4 ]. Most researchers believe that for benign tumors and early malignant tumors (T 1-2 N 0 M 0 ) in that area, the long-term outcomes of local mass resection are similar to those of pancreaticoduodenectomy.…”

Section: Discussionmentioning

confidence: 99%

Pancreas-preserving duodenectomy for treatment of a duodenal papillary tumor: A case report

Wu¹,

Chen²,

Li³

et al. 2021

WJCC

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BACKGROUND Duodenal papillary tumor is a rare tumor of the digestive tract, accounting for about 0.2% of gastrointestinal tumors and 7% of periampullary tumors. The clinical manifestations of biliary obstruction are most common. Some benign tumors or small malignant tumors are often not easily found because they have no obvious symptoms in the early stage. Surgical resection is the only treatment for duodenal papillary tumors. At present, the methods of operation for duodenal papillary tumors include pancreatoduodenectomy, duodenectomy, ampullectomy, and endoscopic resection. CASE SUMMARY A 47-year-old man was admitted to because of a duodenal mass that had been discovered 2 mo previously. Electronic gastroscopy at another hospital revealed a duodenal papillary mass that had been considered to be a high-grade intraepithelial neoplasia. Therefore, we conducted a multidisciplinary group discussion and decided to perform a pancreas-preserving duodenectomy and a R0 resection was successfully performed. After surgery, the patient underwent a follow-up period of 5 yr. No recurrence or metastasis occurred. CONCLUSION According to our experience with a duodenal papillary tumor, compared with pancreaticoduodenectomy, the use of pancreas-preserving duodenectomy can preserve pancreatic function, maintain gastrointestinal structure and function, reduce tissue damage and complications, and render the postoperative recovery faster. Pancreas-preserving duodenectomy for treatment of a duodenal papillary tumor is feasible under strict control of surgical indications.

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“…In contrast, data of surgical ampullectomies are very few, and included between 11 and 44 patients per case series with an R0rate between 63 and 100% (39,(44)(45)(46)(47)(48)(49)(50)(51)(52)(53)(54)(55)(56)(57). Overall complications were between 9 and 68% but 30-day-mortality often was missing.…”

Section: Discussionmentioning

confidence: 99%

Study Protocol of the ESAP Study: Endoscopic Papillectomy vs. Surgical Ampullectomy vs. Pancreaticoduodenectomy for Ampullary Neoplasm—A Pancreas2000/EPC Study

Hollenbach

Ali

Auriemma³

et al. 2020

Front. Med.

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Background: Lesions of the Ampulla of Vater are a rare condition and represent <10% of peri-ampullary neoplasms. Nevertheless, ampullary adenomas have the potential for malignant transformation to ampullary carcinomas by an adenoma-to-carcinoma sequence. Thus, adequate patient selection and complete resection (R0) of non-invasive ampullary lesions either by endoscopic papillectomy (EP), surgical ampullectomy (SA), or pancreaticoduodenectomy (PD) is essential. Although PD was traditionally performed, recent studies reported considerable efficacy and fewer complications following EP and SA. Since consistent comparative data are lacking, the Endoscopic Papillectomy vs. Surgical Ampullectomy vs. Pancreaticoduodectomy (ESAP) study will provide evidence for a therapeutic standard and post procedure morbidity in ampullary lesions. Methods: International multicenter retrospective study. Adult patients (>18 years of age) who underwent SA or PD for ampullary neoplasm between 2004 and 2018 or EP between 2007 and 2018 will be evaluated. Main inclusion criteria are ampullary lesions strictly located to the ampulla. This includes adenoma, adenocarcinoma (T 1 and T 2), neuroendocrine tumors, gastrointestinal stroma tumors and other rare conditions. Exclusion criteria are peri-ampullary lesions, e.g., from the duodenal wall or the head of the pancreas, and interventions for tumor stages higher than T 2. The main objective of this study is to analyze rates of complete resection (R0), recurrence and necessity for complementary interventions following EP, SA, and PD. Treatment-quality for each procedure will be defined by morbidity, mortality and complication rates and will be compared between EP, SA, and PD. Secondary objectives include outcome for patients with incomplete resection or initially understated tumors, lesions of the minor papilla, Hollenbach et al. ESAP hereditary syndromes, neuroendocrine tumors, mesenchymal lesions, and other rare conditions. Additionally, we will analyze therapy by argon plasma coagulation and radiofrequency ablation. Furthermore, outcome in curative and palliative interventions can be distinguished. Conclusion: The ESAP study will provide evidence for therapeutic algorithms and data for the implementation of guidelines in the treatment of different types of ampullary tumors, including recurrent, or incomplete resected lesions.

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Transduodenal ampullectomy for ampullary tumors

Cited by 10 publications

References 10 publications

Systematic Review with Meta-Analysis: Endoscopic and Surgical Resection for Ampullary Lesions

Systematic Review with Meta-Analysis: Endoscopic and Surgical Resection for Ampullary Lesions

Pancreas-preserving duodenectomy for treatment of a duodenal papillary tumor: A case report

Study Protocol of the ESAP Study: Endoscopic Papillectomy vs. Surgical Ampullectomy vs. Pancreaticoduodenectomy for Ampullary Neoplasm—A Pancreas2000/EPC Study

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