Comparison of Oncologic Outcomes Between Transduodenal Ampullectomy and Pancreatoduodenectomy in Ampulla of Vater Cancer: Korean Multicenter Study

Overview

Journal Cancers (Basel)

Publisher MDPI

Specialty Oncology

Date 2021 Apr 30

PMID 33922504

Citations 7

Authors

Seung-Soo Hong

Sung-Sik Han

Wooil Kwon

Jin-Young Jang

Hee-Joon Kim

Chol-Kyoon Cho

Keun-Soo Ahn

Jae-Do Yang

Youngmok Park

Seog-Ki Min

Ju-Ik Moon

Young-Hoon Roh

Seung-Eun Lee

Joon-Seong Park

Sang-Geol Kim

Chi-Young Jeong

Jin-Seok Heo

Ho-Kyoung Hwang

Affiliations

Soon will be listed here.

Abstract

This study used multicenter data to compare the oncological safety of transduodenal ampullectomy (TDA) with that of pylorus-preserving pancreatoduodenectomy (PPPD) in early ampulla of Vater (AoV) cancer. Data for patients who underwent surgical resection for AoV cancer (pTis-T2 stage) from January 2000 to September 2019 were collected from 15 institutions. The clinicopathologic characteristics and survival outcomes were compared between the PPPD and TDA groups. A total of 486 patients were enrolled (PPPD, 418; TDA, 68). The oncologic behavior in the PPPD group was more aggressive than that in the TDA group at all T stages: larger tumor size ( = 0.034), advanced T stage ( < 0.001), aggressive cell differentiation ( < 0.001), and more lymphovascular invasion ( = 0.002). Five-year disease-free survival (DFS) and overall survival (OS) did not differ between the two groups when considering all T stages or only the Tis+T1 group. Among T1 patients, PPPD produced significantly better DFS (PPPD vs. TDA, 84.8% vs. 66.6%, = 0.040) and superior OS (PPPD vs. TDA, 89.1% vs. 68.0%, = 0.056) than TDA. Lymph node dissection (LND) in the TDA group did not affect DFS or OS (TDA + LND vs. TDA-only, DFS, = 0.784; OS, = 0.870). In conclusion, PPPD should be the standard procedure for early AoV cancer.

Citing Articles

Pushing the Boundaries of Ampullectomy for Benign Ampullary Tumors: 25-Year Outcomes of Surgical Ampullary Resection Associated with Duodenectomy or Biliary Resection.

Sorribas M, Carnaval T, Secanella L, Pelaez N, Salord S, Gornals J J Clin Med. 2024; 13(23).

PMID: 39685678 PMC: 11642110. DOI: 10.3390/jcm13237220.

Predicting lymph node metastasis using preoperative parameters in patients with T1 ampulla of vater cancer.

Yoon S, Hong S, Jang K, Yoon S, Kim H, Shin S BMC Cancer. 2024; 24(1):935.

PMID: 39090569 PMC: 11293034. DOI: 10.1186/s12885-024-12311-9.

Outcomes of Palliative Chemotherapy for Ampulla of Vater Adenocarcinoma: A Multicenter Cohort Study.

Jang D, Kim S, Chung H, Lee J, Yoon S, Lee J Gut Liver. 2023; 18(4):729-736.

PMID: 38130162 PMC: 11249934. DOI: 10.5009/gnl230164.

Laparoscopic transduodenal ampullectomy: initial experience from a single center.

Gao P, Cai H, Wu Z, Peng B, Cai Y Front Oncol. 2023; 13:1113490.

PMID: 37519815 PMC: 10374838. DOI: 10.3389/fonc.2023.1113490.

The Optimal Cutoff Value of Tumor Markers for Prognosis Prediction in Ampullary Cancer.

Lee S, Kim H, Sohn H, Lee M, Jung H, Jo Y Cancers (Basel). 2023; 15(8).

PMID: 37190211 PMC: 10136701. DOI: 10.3390/cancers15082281.

References

Jung Y, Paik S, Choi D, Lee K . Transduodenal ampullectomy for ampullary tumor. Asian J Surg. 2021; 44(5):723-729. DOI: 10.1016/j.asjsur.2020.12.021. View

Park J, Yoon D, Kim K, Choi J, Lee W, Chi H . Factors influencing recurrence after curative resection for ampulla of Vater carcinoma. J Surg Oncol. 2007; 95(4):286-90. DOI: 10.1002/jso.20665. View

Ahn D, Bekaii-Saab T . Ampullary cancer: an overview. Am Soc Clin Oncol Educ Book. 2014; :112-5. PMC: 4966534. DOI: 10.14694/EdBook_AM.2014.34.112. View

Lee H, Park J, Kwon W, Heo J, Choi D, Choi S . Transduodenal Ampullectomy for the Treatment of Early-Stage Ampulla of Vater Cancer. World J Surg. 2015; 40(4):967-73. DOI: 10.1007/s00268-015-3316-x. View

WHIPPLE A . Observations on radical surgery for lesions of the pancreas. Surg Gynecol Obstet. 2010; 82:623-31. View

Demetriades H, Zacharakis E, Kirou I, Pramateftakis M, Sapidis N, Kanellos I . Local excision as a treatment for tumors of ampulla of Vater. World J Surg Oncol. 2006; 4:14. PMC: 1421403. DOI: 10.1186/1477-7819-4-14. View

Liu F, Cheng J, Cui J, Xu Z, Fu Z, Liu J . Surgical method choice and coincidence rate of pathological diagnoses in transduodenal ampullectomy: A retrospective case series study and review of the literature. World J Clin Cases. 2019; 7(6):717-726. PMC: 6448071. DOI: 10.12998/wjcc.v7.i6.717. View

Yoon S, Kim M, Kim M, Jang S, Lee T, Kwon S . Focal early stage cancer in ampullary adenoma: surgery or endoscopic papillectomy?. Gastrointest Endosc. 2007; 66(4):701-7. DOI: 10.1016/j.gie.2007.02.049. View

OConnell J, Maggard M, Manunga Jr J, Tomlinson J, Reber H, Ko C . Survival after resection of ampullary carcinoma: a national population-based study. Ann Surg Oncol. 2008; 15(7):1820-7. DOI: 10.1245/s10434-008-9886-1. View

10.

Kobayashi A, Konishi M, Nakagohri T, Takahashi S, Kinoshita T . Therapeutic approach to tumors of the ampulla of Vater. Am J Surg. 2006; 192(2):161-4. DOI: 10.1016/j.amjsurg.2006.05.002. View

11.

Chung Y, Kim M, Park M, Choi J, Kim H, Kim S . Differential features of pancreatobiliary- and intestinal-type ampullary carcinomas at MR imaging. Radiology. 2010; 257(2):384-93. DOI: 10.1148/radiol.10100200. View

12.

Yeo C, Cameron J, Sohn T, Lillemoe K, Pitt H, Talamini M . Six hundred fifty consecutive pancreaticoduodenectomies in the 1990s: pathology, complications, and outcomes. Ann Surg. 1997; 226(3):248-57; discussion 257-60. PMC: 1191017. DOI: 10.1097/00000658-199709000-00004. View

13.

Yoon Y, Kim S, Park S, Lee H, Jang J, Choi M . Clinicopathologic analysis of early ampullary cancers with a focus on the feasibility of ampullectomy. Ann Surg. 2005; 242(1):92-100. PMC: 1357709. DOI: 10.1097/01.sla.0000167853.04171.bb. View

14.

Westgaard A, Tafjord S, Farstad I, Cvancarova M, Eide T, Mathisen O . Pancreatobiliary versus intestinal histologic type of differentiation is an independent prognostic factor in resected periampullary adenocarcinoma. BMC Cancer. 2008; 8:170. PMC: 2430209. DOI: 10.1186/1471-2407-8-170. View

15.

Gao Y, Zhu Y, Huang X, Wang H, Huang X, Yuan Z . Transduodenal ampullectomy provides a less invasive technique to cure early ampullary cancer. BMC Surg. 2016; 16(1):36. PMC: 4888619. DOI: 10.1186/s12893-016-0156-z. View

16.

Bouvet M, Gamagami R, Gilpin E, Romeo O, Sasson A, Easter D . Factors influencing survival after resection for periampullary neoplasms. Am J Surg. 2000; 180(1):13-7. DOI: 10.1016/s0002-9610(00)00405-0. View

17.

Kim A, Choi Y . Safety of duodenal ampullectomy for benign periampullary tumors. Ann Hepatobiliary Pancreat Surg. 2017; 21(3):146-150. PMC: 5620475. DOI: 10.14701/ahbps.2017.21.3.146. View

18.

BRUNSCHWIG A . Resection of head of pancreas and duodenum for carcinoma--pancreatoduodenectomy. CA Cancer J Clin. 1974; 24(6):363-7. DOI: 10.3322/canjclin.24.6.363. View

19.

Dittrick G, Mallat D, Lamont J . Management of ampullary lesions. Curr Treat Options Gastroenterol. 2006; 9(5):371-6. DOI: 10.1007/BF02738525. View

20.

Lai J, Shyr Y, Wang S . Ampullectomy versus pancreaticoduodenectomy for ampullary tumors. J Chin Med Assoc. 2015; 78(6):339-44. DOI: 10.1016/j.jcma.2015.02.002. View