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

Elias Karam; Marcus Hollenbach; Einas Abou Ali; Francesco Auriemma; Aiste Gulla; Christian Heise; Sara Regner; Sébastien Gaujoux; Jean M. Regimbeau; Georg Kähler; Steffen Seyfried; Jean C. Vaillant; Charles De Ponthaud; Alain Sauvanet; David Birnbaum; Nicolas Regenet; Stéphanie Truant; Enrique Pérez-Cuadrado-Robles; Matthieu Bruzzi; Renato M. Lupinacci; Martin Brunel; Giulio Belfiori; Louise Barbier; Ephrem Salamé; Francois R. Souche; Lilian Schwarz; Laura Maggino; Roberto Salvia; Johan Gagniére; Marco Del Chiaro; Galen Leung; Thilo Hackert; Tobias Kleemann; Woo H. Paik; Karel Caca; Ana Dugic; Steffen Muehldorfer; Brigitte Schumacher; David Albers; on the Pancreas 2000 Research Group

doi:10.1016/j.surg.2022.12.011

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

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

Elias Karam, Marcus Hollenbach, Einas Abou Ali, Francesco Auriemma, Aiste Gulla, Christian Heise, Sara Regner, Sébastien Gaujoux, Jean M. Regimbeau, Georg Kähler, …

Surgery, Vol.173(5), pp.1254-1262

01/05/2023

DOI: https://doi.org/10.1016/j.surg.2022.12.011

PMID: 36642655

Résumé

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. 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. 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. 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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Titre: Outcomes of rescue procedures in the management of locally recurrent ampullary tumors: A Pancreas 2000/EPC study
Créateurs - sans rôle: Elias Karam - Department of Visceral Surgery, Hepato-Biliary, Pancreatic and Liver Transplantation Unit, Tours University Hospital, France
Marcus Hollenbach - University of Leipzig Medical Center, Medical Department II–Gastroenterology, Hepatology, Infectious Diseases, Pulmonology, Leipzig, Germany
Einas Abou Ali - Department of Gastroenterology, Digestive Oncology, and Endoscopy, Cochin Hospital, Paris, France
Francesco Auriemma - Humanitas Clinical and Research Hospital, Rozzano, Digestive Endoscopy Unit, Division of Gastroenterology, Milan, Italy
Aiste Gulla - Department of Surgery, Lithuanian University of Health Sciences, Kaunas, Lithuania
Christian Heise - Martin-Luther University Halle-Wittenberg Department of Medicine I–Gastroenterology, Pulmonology, Halle, Germany
Sara Regner - Department of Clinical Sciences Malmö, Lund University, Sweden
Sébastien Gaujoux - Department of Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, AP-HP Pitié-Salpêtrière Hospital, Paris, France
Jean M. Regimbeau - Department of Digestive Surgery, Center Hospitalo-Universitaire Amiens-Picardie, Amiens, France
Georg Kähler - Interdisciplinary Endoscopy Unit, Mannheim Medical Center, Ruprecht-Karls-University Heidelberg, Mannheim, Germany
Steffen Seyfried - Interdisciplinary Endoscopy Unit, Mannheim Medical Center, Ruprecht-Karls-University Heidelberg, Mannheim, Germany
Jean C. Vaillant - Department of Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, AP-HP Pitié-Salpêtrière Hospital, Paris, France
Charles De Ponthaud - Department of Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, AP-HP Pitié-Salpêtrière Hospital, Paris, France
Alain Sauvanet - Department of Digestive Surgery, Beaujon Hospital, APHP, Clichy, France
David Birnbaum - Assistance Publique Hôpitaux de Marseille
Nicolas Regenet - Centre Hospitalier Universitaire de Nantes
Stéphanie Truant - Deparment of Digestive Surgery, Centre Hospitalo-Universitaire de Lille, France
Enrique Pérez-Cuadrado-Robles - Department of Gastroenterology, Georges-Pompidou European Hospital, APHP.Centre, University of Paris, France
Matthieu Bruzzi - Department of Digestive Surgery, Hôpital Européen Georges Pompidou, APHP, Paris, France
Renato M. Lupinacci - Groupe Hospitalier Diaconesses Croix Saint-Simon
Martin Brunel - Department of Digestive Surgery, Hôpital André Mignot, Versailles, France
Giulio Belfiori - Vita-Salute San Raffaele University
Louise Barbier - Department of Visceral Surgery, Hepato-Biliary, Pancreatic and Liver Transplantation Unit, Tours University Hospital, France
Ephrem Salamé - Department of Visceral Surgery, Hepato-Biliary, Pancreatic and Liver Transplantation Unit, Tours University Hospital, France
Francois R. Souche - Department of Digestive Surgery, Centre Hospitalier Universitaire de Montpellier, France
Lilian Schwarz - Department of Digestive Surgery, Hôpital Charles-Nicolle, Centre Hospitalier Universitaire de Rouen, France
Laura Maggino - Unit of General and Pancreatic Surgery, The Pancreas Institute Verona, Department of Surgery, Dentistry, Paediatrics, and Gynaecology, University of Verona, Italy
Roberto Salvia - Unit of General and Pancreatic Surgery, The Pancreas Institute Verona, Department of Surgery, Dentistry, Paediatrics, and Gynaecology, University of Verona, Italy
Johan Gagniére - Department of Digestive and Hepatobiliary Surgery, Estaing University Hospital, Clermont-Ferrand, France
Marco Del Chiaro - Department of Surgery, University of Colorado Anschutz Medical Campus, CO
Galen Leung - Division of Gastroenterology and Hepatology, University of Pennsylvania Perelman School of Medicine, PA
Thilo Hackert - Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Germany
Tobias Kleemann - Department of Gastroenterology and Rheumatology, Carl-Thiem-Klinikum Cottbus, Germany
Woo H. Paik - Division of Gastroenterology, Department of Internal Medicine, Seoul National University Hospital, Republic of Korea
Karel Caca - Department of Medicine, Gastroenterology, Hematology, Oncology, Pneumology, Diabetes and Infectious Diseases, RKH Clinic Ludwigsburg, Germany
Ana Dugic - Department of Gastroenterology, Friedrich-Alexander-University Erlangen-Nuremberg, Medical Campus Oberfranken, Bayreuth, Germany
Steffen Muehldorfer - Department of Gastroenterology, Friedrich-Alexander-University Erlangen-Nuremberg, Medical Campus Oberfranken, Bayreuth, Germany
Brigitte Schumacher - Department of Medicine and Gastroenterology, Contilia Clinic Essen, Germany
David Albers - Department of Medicine and Gastroenterology, Contilia Clinic Essen, Germany
on the Pancreas 2000 Research Group
Détails de publication: Surgery, Vol.173(5), pp.1254-1262
Éditeur: Elsevier Inc
Nombre de pages: 9
Identifiants: 99140127209311
Unité académique: Institut de Recherche en Cancérologie de Montpellier - IRCM
Langue: English
Type de ressource: Journal article