Outcomes of rescue procedures in the management of locally recurrent ampullary tumors: A Pancreas 2000/EPC study

Karam E, Hollenbach M, Ali EA, Auriemma F, Gulla A, Heise C, Regner S, Gaujoux S, Regimbeau JM, Kähler G, Seyfried S, Vaillant JC, De Ponthaud C, Sauvanet A, Birnbaum D, Regenet N, Truant S, Pérez-Cuadrado-Robles E, Bruzzi M, Lupinacci RM, Brunel M, Belfiori G, Barbier L, Salamé E, Souche FR, Schwarz L, Maggino L, Salvia R, Gagniére J, Del Chiaro M, Leung G, Hackert T, Kleemann T, Paik WH, Caca K, Dugic A, Mühldorfer S, Schumacher B, Albers D (2023)

Publication Type: Journal article

Publication year: 2023

Journal

DOI: 10.1016/j.surg.2022.12.011

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.

Authors with CRIS profile

Involved external institutions

Hôpital Cochin France (FR) François Rabelais University Tours France (FR) Universität Leipzig Germany (DE) Martin-Luther-Universität Halle-Wittenberg (MLU) Germany (DE) Humanitas Research Hospital / IRCCS Istituto Clinico Humanitas Italy (IT) Lithuanian University of Health Sciences / Lietuvos sveikatos mokslų universitetas (LSMU) Lithuania (LT) Pitié-Salpêtrière University Hospital / Hôpital universitaire Pitié-Salpêtrière France (FR) Lund University / Lunds universitet Sweden (SE) Centre Hospitalier Universitaire Amiens-Picardie (CHU Amiens-Picardie) France (FR) Ruprecht-Karls-Universität Heidelberg Germany (DE) Centre Hospitalier Universitaire de Montpellier (CHU/CHRU MTP) France (FR) Beaujon Hospital / Hôpital Beaujon France (FR) Aix-Marseille University / Aix-Marseille 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) Georges Pompidou European Hospital / Hôpital Européen Georges-Pompidou (HEGP) France (FR) Groupe Hospitalier Diaconesses Croix Saint-Simon (DCSS) France (FR) Centre Hospitalier de Versailles France (FR) Università Vita-Salute San Raffaele (UniSR) Italy (IT) Hospital Center University Rouen / Centre hospitalier universitaire de Rouen (CHU) France (FR) University of Verona / Università degli Studi di Verona Italy (IT) CHU Clermont-Ferrand France (FR) University of Colorado Anschutz Medical Campus United States (USA) (US) Perelman School of Medicine University of Pennsylvania United States (USA) (US) Carl-Thiem-Klinikum Germany (DE) Contilia GmbH Germany (DE) Seoul National University (SNU) / 서울대학교 Korea, Republic of (KR)

How to cite

APA:

Karam, E., Hollenbach, M., Ali, E.A., Auriemma, F., Gulla, A., Heise, C.,... Albers, D. (2023). Outcomes of rescue procedures in the management of locally recurrent ampullary tumors: A Pancreas 2000/EPC study. Surgery. https://doi.org/10.1016/j.surg.2022.12.011

MLA:

Karam, Elias, et al. "Outcomes of rescue procedures in the management of locally recurrent ampullary tumors: A Pancreas 2000/EPC study." Surgery (2023).

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