BACKGROUND: Recently, the evidence has been accumulating that endoscopic resection may be curative in treating ampullary adenoma that contains high-grade intraepithelial neoplasia/in situ tumor (HGIN/Tis). However, there are only anecdotal reports of endoscopic management of "focal" T1 ampullary cancer (T1 cancer), and radical surgery is still considered the only accepted treatment modality. OBJECTIVE: To assess the possibility of endoscopic papillectomy as an alternative to radical surgery for the treatment of ampullary adenoma with HGIN/Tis or focal T1 cancer. DESIGN: Retrospective evaluation of case series of our hospital from 1996 to 2006. SETTING: Tertiary-care university teaching hospital. PATIENTS: Twenty-three patients who had HGIN/Tis or focal T1 cancer in ampullary adenoma resected by endoscopic papillectomy and 60 patients who initially underwent radical surgery for HGIN/Tis or T1 cancer of the ampulla of Vater. "Focal" was defined as a lesion involving only mucosa, with a size less than a fourth the diameter of main adenoma. INTERVENTIONS: Review of medical records and analysis of surgically or endoscopically resected specimens of ampullary tumors. MAIN OUTCOME MEASUREMENTS: Locoregional extension and follow-up data. RESULTS: Patients with HGIN/Tis of the ampulla of Vater had no lymphovascular invasion or lymph-node metastasis, and there were no occurrences of cancer or deaths during a mean (standard error [+/-SE]) 27.1 +/- 5.9 months after endoscopic papillectomy. T1 cancer was shown to have lymphovascular invasion and/or lymph-node metastasis in 10.7% and duct mucosal involvement in another 17.9%. Among them, patients with focal T1 cancer showed no lymphovascular invasion or lymph-node metastasis and no ductal involvement, and none of the patients who underwent endoscopic papillectomy alone had cancer recurrence or disease-related death for mean (+/-SE) 32.2 +/- 6.7 months. LIMITATIONS: Single-center, retrospective study, small number of patients, and medium-term follow-up period. CONCLUSIONS: Endoscopic papillectomy may be a curative treatment for ampullary adenoma with HGIN/Tis and should also be considered as an alternative to surgery in focal T1 cancer in ampullary adenoma.
BACKGROUND: Recently, the evidence has been accumulating that endoscopic resection may be curative in treating ampullary adenoma that contains high-grade intraepithelial neoplasia/in situ tumor (HGIN/Tis). However, there are only anecdotal reports of endoscopic management of "focal" T1 ampullary cancer (T1 cancer), and radical surgery is still considered the only accepted treatment modality. OBJECTIVE: To assess the possibility of endoscopic papillectomy as an alternative to radical surgery for the treatment of ampullary adenoma with HGIN/Tis or focal T1 cancer. DESIGN: Retrospective evaluation of case series of our hospital from 1996 to 2006. SETTING: Tertiary-care university teaching hospital. PATIENTS: Twenty-three patients who had HGIN/Tis or focal T1 cancer in ampullary adenoma resected by endoscopic papillectomy and 60 patients who initially underwent radical surgery for HGIN/Tis or T1 cancer of the ampulla of Vater. "Focal" was defined as a lesion involving only mucosa, with a size less than a fourth the diameter of main adenoma. INTERVENTIONS: Review of medical records and analysis of surgically or endoscopically resected specimens of ampullary tumors. MAIN OUTCOME MEASUREMENTS: Locoregional extension and follow-up data. RESULTS:Patients with HGIN/Tis of the ampulla of Vater had no lymphovascular invasion or lymph-node metastasis, and there were no occurrences of cancer or deaths during a mean (standard error [+/-SE]) 27.1 +/- 5.9 months after endoscopic papillectomy. T1 cancer was shown to have lymphovascular invasion and/or lymph-node metastasis in 10.7% and duct mucosal involvement in another 17.9%. Among them, patients with focal T1 cancer showed no lymphovascular invasion or lymph-node metastasis and no ductal involvement, and none of the patients who underwent endoscopic papillectomy alone had cancer recurrence or disease-related death for mean (+/-SE) 32.2 +/- 6.7 months. LIMITATIONS: Single-center, retrospective study, small number of patients, and medium-term follow-up period. CONCLUSIONS: Endoscopic papillectomy may be a curative treatment for ampullary adenoma with HGIN/Tis and should also be considered as an alternative to surgery in focal T1 cancer in ampullary adenoma.
Authors: Albert Amini; John T Miura; Thejus T Jayakrishnan; Fabian M Johnston; Susan Tsai; Kathleen K Christians; T Clark Gamblin; Kiran K Turaga Journal: HPB (Oxford) Date: 2014-11-14 Impact factor: 3.647
Authors: Wim Laleman; Annelies Verreth; Baki Topal; Raymond Aerts; Mina Komuta; Tania Roskams; Schalk Van der Merwe; David Cassiman; Frederik Nevens; Chris Verslype; Werner Van Steenbergen Journal: Surg Endosc Date: 2013-05-25 Impact factor: 4.584
Authors: Keith J Roberts; Neil McCulloch; Rob Sutcliffe; John Isaac; Paolo Muiesan; Simon Bramhall; Darius Mirza; Ravi Marudanayagam; Brinder S Mahon Journal: HPB (Oxford) Date: 2012-08-20 Impact factor: 3.647