Gastrointestinal endoscopy · 2007
Focal early stage cancer in ampullary adenoma: surgery or endoscopic papillectomy?
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Yoon Soon Man, Kim Myung-Hwan, Kim Mi Jung, Jang Se Jin, Lee Tae Yoon, Kwon Seunghyun, Oh Hyoung-Chul, Lee Sang Soo, Seo Dong Wan, Lee Sung Koo
Аннотация
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.
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.