Abstract
Background
Ampullary lesions are rare and can be locally treated either with endoscopic papillectomy
or transduodenal surgical ampullectomy. Management of local recurrence after a first-line
treatment has been poorly studied.
Methods
Patients with a local recurrence of an ampullary lesion initially treated with endoscopic
papillectomy or transduodenal surgical ampullectomy were retrospectively included
from a multi-institutional database (58 centers) between 2005 and 2018.
Results
A total of 103 patients were included, 21 (20.4%) treated with redo endoscopic papillectomy,
14 (13.6%) with transduodenal surgical ampullectomy, and 68 (66%) with pancreaticoduodenectomy.
Redo endoscopic papillectomy had low morbidity with 4.8% (n = 1) severe to fatal complications and a R0 rate of 81% (n = 17). Transduodenal surgical ampullectomy and pancreaticoduodenectomy after a first
procedure had a higher morbidity with Clavien III and more complications, respectively,
28.6% (n = 4) and 25% (n = 17); R0 resection rates were 85.7% (n = 12) and 92.6% (n = 63), both without statistically significant difference compared to endoscopic papillectomy
(P = .1 and 0.2). Pancreaticoduodenectomy had 4.4% (n = 2) mortality. No deaths were registered after transduodenal surgical ampullectomy
or endoscopic papillectomy. Recurrences treated with pancreaticoduodenectomy were
more likely to be adenocarcinomas (79.4%, n = 54 vs 21.4%, n = 3 for transduodenal surgical ampullectomy and 4.8%, n = 1 for endoscopic papillectomy, P < .0001). Three-year overall survival and disease-free survival were comparable.
Conclusion
Endoscopy is appropriate for noninvasive recurrences, with resection rate and survival
outcomes comparable to surgery. Surgery applies more to invasive recurrences, with
transduodenal surgical ampullectomy rather for carcinoma in situ and early cancers
and pancreaticoduodenectomy for more advanced tumors.
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Article info
Publication history
Published online: January 13, 2023
Accepted:
December 13,
2022
Publication stage
In Press Corrected ProofFootnotes
Elias Karam and Marcus Hollenbach contributed equally to the work.
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
