Endoscopic papillectomy versus surgical ampullectomy for adenomas and early cancers of the papilla: a retrospective Pancreas2000/European Pancreatic Club analysis.

Autor:	Hollenbach M; Department of Gastroenterology, Endocrinology, Metabolism and Clinical Infectiology, University Hospital of Giessen and Marburg Campus Marburg, Marburg, Germany marcus.hollenbach@web.de.; Division of Gastroenterology, Medical Department II, University of Leipzig Medical Center, Leipzig, Germany., Heise C; Medical Department I, Martin-Luther-Universitat Halle-Wittenberg, Halle, Germany.; Medical Department IV, Heidelberg University, Heidelberg, Germany., Abou-Ali E; Department of Gastroenterology, Digestive Oncology and Endoscopy, Paris Descartes University Paris, Paris, France., Gulla A; Department of Surgery, George Washington University, School of Medicine and Health Sciences, Washington DC, District of Columbia, USA.; Center of Abdominal Center, Vilnius University hospital Santaros clinics, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania., Auriemma F; Gastrointestinal Endoscopy, Humanitas Mater Domini, Castellanza, Italy., Soares K; Hepatopancreatobiliary Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA., Leung G; Division of Gastroenterology and Hepatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA., Schattner MA; Gastroenterology, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA., Jarnagin WR; Hepatopancreatobiliary Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA., Wang T; Hepatopancreatobiliary Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA.; Department of Surgery, Cangzhou Central Hospital, Hebei, China., Caillol F; Digestive Endoscopy Department, Institut Paoli Calmettes, Marseille, France., Giovannini M; Digestive Endoscopy Department, Institut Paoli Calmettes, Marseille, France., Dahel Y; Digestive Endoscopy Department, Institut Paoli Calmettes, Marseille, France., Hackert T; Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany., Paik WH; Division of Gastroenterology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea., Zerbi A; Department of Biochemical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.; Pancreatic Surgery Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy., Nappo G; Department of Biochemical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.; Pancreatic Surgery Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy., Napoleon B; Endoscopie Digestive, hopital privé Jean Mermoz, Générale de Santé, Lyon, France., Arnelo U; Division of Surgery, CLINTEC, Karolinska Institutet, Stockholm, Sweden.; Department of Surgical and Perioperative Sciences, Surgery, Umea University, Umea, Sweden., Haraldsson E; Division of Surgery, CLINTEC, Karolinska Institutet, Stockholm, Sweden.; Department of Surgery, Skaraborg Hospital, Skovde, Sweden., Halimi A; Division of Surgery, CLINTEC, Karolinska Institutet, Stockholm, Sweden.; Department of Surgical and Perioperative Sciences, Surgery, Umea University, Umea, Sweden., Waldthaler A; Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden.; Department of Medicine Huddinge, Karolinska University Hospital, Stockholm, Sweden., Will U; Department of Gastroenterology, Hepatology, Diabetology and General Internal Medicine, SRH Wald-Klinikum Gera GmbH, Gera, Germany., Saadeh R; Department of Gastroenterology, Hepatology, Diabetes and General Internal Medicine, SRH Wald-Klinikum Gera, Gera, Germany., Masaryk V; Department of Gastroenterology, Hepatology, Diabetes and General Internal Medicine, SRH Wald-Klinikum Gera, Gera, Germany., van der Wiel SE; Department of Gastroenterology and Hepatology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, The Netherlands., Bruno MJ; Department of Gastroenterology and Hepatology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, The Netherlands., Perez-Cuadrado-Robles E; Interventional Endoscopy, Department of Gastroenterology, Georges-Pompidou European Hospital, Paris, France.; Department of Gastroenterology, Cliniques universitaires Saint-Luc, Bruxelles, Belgium., Deprez P; Department of Gastroenterology, Cliniques universitaires Saint-Luc, Bruxelles, Belgium., Sauvanet A; Departement of Digestive Surgery, Beaujon Hospital APHP, Clichy, France., Bolm L; Department of Surgery, University Medical Center Schleswig Holstein, Campus Luebeck, Luebeck, Germany., Keck T; Department of Surgery, University Medical Center Schleswig Holstein, Campus Luebeck, Luebeck, Germany., Souche R; Department of Digestive Surgery, Centre Hospitalier Universitaire de Montpellier, Montpellier, France., Fabre JM; Department of Digestive and Transplantation Surgery, Centre Hospitalier Universitaire de Montpellier, Montpellier, France., Musquer N; Clinique Santé Atlantique, Saint Herblain, France., Kähler G; Interdisziplinary Endoscopy Unit, Mannheim Medical Center, Ruprecht Karls University Heidelberg Faculty of Medicine, Mannheim, Germany.; Department of Surgery, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany., Seyfried S; Interdisziplinary Endoscopy Unit, Mannheim Medical Center, Ruprecht Karls University Heidelberg Faculty of Medicine, Mannheim, Germany.; Department of Surgery, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany., Petrone MC; Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational & Clinical Research Center, San Raffaele Scientific Institute IRCCS, Vita-Salute San Raffaele University, Milan, Italy., Mariani A; Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational & Clinical Research Center, San Raffaele Scientific Institute IRCCS, Vita-Salute San Raffaele University, Milan, Italy., Zaccari P; Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational & Clinical Research Center, San Raffaele Scientific Institute IRCCS, Vita-Salute San Raffaele University, Milan, Italy., Belfiori G; Department of Pancreatic Surgery, Vita-Salute San Raffaele University, Milano, Italy., Crippa S; Department of Pancreatic Surgery, Vita-Salute San Raffaele University, Milano, Italy., Falconi M; Department of Pancreatic Surgery, Vita-Salute San Raffaele University, Milano, Italy., Partelli S; Department of Pancreatic Surgery, Vita-Salute San Raffaele University, Milano, Italy., Yilmaz B; Department of Surgery, TUM University Hospital, Klinikum rechts der Isar, Munich, Germany., Demir IE; Department of Surgery, TUM University Hospital, Klinikum rechts der Isar, Munich, Germany.; Else Kröner Clinician Scientist Professor for Translational Pancreatic Surgery, TUM University Hospital, Klinikum rechts der Isar, Munich, Germany., Ceyhan GO; Department of General Surgery, HPB-Unit, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey., Satoi S; Department of Surgery, Kansai Medical University, Hirakata, Osaka, Japan.; Department of Surgery, University of Colorado - Anschutz Medical Campus, Aurora, Colorado, USA., Regimbeau JM; Departement of Digestive Surgery, Centre hospitalo-universitaire Amiens-Picardie, Amiens, France., Gagniére J; Department of Digestive and Hepatobiliary Surgery, Estaing University Hospital, Clermont-Ferrand, France.; U1071 Inserm, Clermont-Auvergne University, Clermont-Ferrand, France., Repici A; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy.; Endoscopy Unit, Humanitas Clinical and Research Center - IRCCS, Rozzano, Italy., Anderloni A; Gastroenterology and Digestive Endoscopy Unit, IRCCS Foundation Policlinico San Matteo, Pavia, Italy., Vollmer C; Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA., Casciani F; Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA.; Unit of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy., Del Chiaro M; Department of Surgery, University of Colorado School of Medicine - Anschutz Medical Campus, Aurora, Colorado, USA., Oba A; Department of Surgery, University of Colorado - Anschutz Medical Campus, Aurora, Colorado, USA., Schulick RD; Department of Surgery, University of Colorado School of Medicine - Anschutz Medical Campus, Aurora, Colorado, USA., Berger A; Department of Gastroenterology and digestive endoscopy, CHU Bordeaux, Bordeaux, France., Maggino L; Unit of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy., Salvia R; Unit of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy., Schemmer P; Department of General, Visceral and Transplantation Surgery, University of Graz, Graz, Austria., Wichmann D; Department of General, Visceral and Transplantation Surgery, University Hospital of Tübingen, Tubingen, Germany., Inoue Y; Department of Hepato-Biliary-Pancreatic Surgery, Cancer Institute Hospital, Tokyo, Japan., Dinis-Ribeiro M; Department of Gastroenterology, Instituto Português de Oncologia do Porto, Porto, Portugal.; RISE@CI-IPO (Health Research Network), Portuguese Oncology Institute of Porto (IPO Porto), Porto, Portugal., Laranjo A; Department of Gastroenterology, Instituto Português de Oncologia do Porto, Porto, Portugal., Libanio D; Department of Gastroenterology, Instituto Português de Oncologia do Porto, Porto, Portugal.; RISE@CI-IPO (Health Research Network), Portuguese Oncology Institute of Porto (IPO Porto), Porto, Portugal., Kleemann T; Department of Gastroenterology and Rheumatology, Carl-Thiem-Klinikum Cottbus, Cottbus, Germany., Sandru V; Department of Gastroenterology and Interventional Endoscopy, Clincal Emergency Hospital, Bucuresti, Romania.; Carol Davila University of Medicine and Pharmacy, Bucuresti, Romania., Ilie M; Carol Davila University of Medicine and Pharmacy, Bucuresti, Romania.; Clinical Emergency Hospital, Bucuresti, Romania., Ahola R; Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.; Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland., Laukkarinen J; Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.; Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland., Schumacher B; Department of Medicine and Gastroenterology, Contilia Clinic Essen, Essen, Germany., Albers D; Department of Medicine and Gastroenterology, Contilia Clinic Essen, Essen, Germany., Cúrdia Gonçalves T; Department of Gastroenterology, Unidade Local de Saúde do Alto Ave, Hospital de Guimarães, Guimaraes, Portugal.; School of Medicine, Life and Health Sciences Research Institute, University of Minho, Braga, Portugal.; ICVS/3B's, PT Government Associate Laboratory, Braga, Portugal., Barbier L; Departement of Digestive Surgery, Centre hospitalo-universitaire de Tours, Tours, France., Salamé E; Departement of Digestive Surgery, Centre hospitalo-universitaire de Tours, Tours, France., Weismüller TJ; Department of Internal Medicine - Gastroenterology and Oncology, Vivantes Humboldt Hospital, Berlin, Germany.; Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany., Heling D; Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany., Alves A; Calvados Digestive Cancer Registry, INSERM U1086 ANTICIPE, Normandy Caen University, Caen, France.; Department of Digestive Surgery, University Hospital Centre, Caen, France., Karam E; Departement of Digestive Surgery, Centre hospitalo-universitaire de Tours, Tours, France., Regenet N; Department of Digestive Surgery, Centre Hospitalier Universitaire de Nantes, Nantes, France., Dugic A; Medical Department IV, Heidelberg University, Heidelberg, Germany.; Department of Gastroenterology, Friedrich-Alexander-University Erlangen-Nuremberg, Medical Campus Oberfranken, Bayreuth, Germany., Muehldorfer S; Department of Gastroenterology, Friedrich-Alexander-University Erlangen-Nuremberg, Medical Campus Oberfranken, Bayreuth, Germany., Truant S; Deparment of Digestive Surgery, Centre hospitalo-universitaire de Lille, Lille, France., Caca K; Department of Medicine, Gastroenterology, Hematology, Oncology, Pneumology, Diabetes and Infectious Diseases, RKH Clinic Ludwigsburg, Ludwigsburg, Germany., Meier B; Department of Medicine, Gastroenterology, Hematology, Oncology, Pneumology, Diabetes and Infectious Diseases, RKH Clinic Ludwigsburg, Ludwigsburg, Germany., Miutescu BP; Department of Gastroenterology and Hepatology, Victor Babeș University of Medicine and Pharmacy, Timișoara, Romania., Tantau M; Hepatology Department, Regional Institute of Gastroenterology and Hepatology Prof Dr Octavian Fodor, Cluj-Napoca, Romania.; 3rd Medical Clinic, Iuliu Hagieganu University of Medicine and Pharmacy Faculty of Medicine, Cluj Napoca, Romania., Birnbaum D; Department of Digestive Surgery, Aix-Marseille University, Marseille, France., Miksch RC; Department of General, Visceral, and Transplantation Surgery, Ludwig Maximilian University Munich, Munich, Germany., Wedi E; Department of Gastroenterology, Gastrointestinal Oncology and Interventional Endoscopy, Sana Clinic Offenbach, Offenbach, Germany.; Department of Gastroenterology and Gastrointestinal Oncology, University of Göttingen, Gottingen, Germany., Salzmann K; Department of Gastroenterology and Gastrointestinal Oncology, University of Göttingen, Gottingen, Germany., Bruzzi M; Department of Digestive Surgery, Hôpital Européen Georges Pompidou, APHP, Paris, France., Lupinacci RM; Department of Digestive Surgery, Groupe hospitalier Diaconesses Croix Saint-Simon, Paris, France., David P; Department of Digestive Surgery, Hopital Louis Pasteur, Colmar, France., De Ponthaud C; Department of Pancreatic and Endocrine Surgery, Pitié-Salpetriere Hospital, Médecine Sorbonne Université, APHP, Paris, France., Schmidt A; Department of Medicine II, Medical Center-University of Freiburg, Freiburg, Germany.; Department of Gastroenterology, Robert Bosch Hospital / Bosch Health Campus, Stuttgart, Germany., Regnér S; Surgery Research Unit, Department of Clinical Sciences Malmö, Skåne University Hospital, Lund University, Malmö, Sweden., Gaujoux S; Department of Digestive and HBP Surgery, Groupe Hospitalier Pitié-Salpêtrière, Médecine Sorbonne Université APHP, Paris, France.
Jazyk:	angličtina
Zdroj:	Gut [Gut] 2024 Dec 12. Date of Electronic Publication: 2024 Dec 12.
DOI:	10.1136/gutjnl-2022-327996
Abstrakt:	Objective: Ampullary neoplastic lesions can be resected by endoscopic papillectomy (EP) or transduodenal surgical ampullectomy (TSA) while pancreaticoduodenectomy is reserved for more advanced lesions. We present the largest retrospective comparative study analysing EP and TSA. Design: Of all patients in the database, lesions with prior interventions, benign histology advanced malignancy (T2 and more), patients with hereditary syndromes and those undergoing pancreatoduodenectomy were excluded. All remaining cases as well as a subgroup of them, after propensity-score matching (nearest-neighbour-method) based on age, gender, anthropometrics, comorbidities, size and histological subtype, were analysed. The median follow-up was 21 months (IQR 10-47) after the primary intervention. Primary outcomes were rates of complete resection (R0) and complications. Groups were compared by Fisher's exact or χ 2 test, Mann-Whitney-U-test and log-rank test for survival. Results: Of 1673 patients in the database, 1422 underwent EP and 251 TSA. Of them, 23.2% were excluded for missing or inconclusive data and 19.8% of patients for prior interventions or hereditary syndromes. Final histology showed in 24.2% of EP and 14.8% of TSA patients a histology other than adenoma or adenocarcinoma while advanced cancers were recorded in 10.9% of EP and 36.6% of TSA patients. Finally, 569 EP and 63 TSA were included in the overall analysis, with a higher rate of more advanced cases and higher R0 resection rates in the TSA groups (90.5% vs 73.1%; p<0.01), with additional ablation in the EP group in 14.4%. Severe adverse event rates were 3.2% (TSA) vs 1.9% (EP). Recurrence after histological R0 resection was 16% (EP) vs 3.2% (TSA; p=0.01), and additional therapy for R1 resection was applied in 67% of the 159 cases. Propensity-score-based matching identified 62 pairs of EP/TSA patients with comparable baseline patient and lesion characteristics. The initial R0-rate was 72.6% (EP) compared with 90.3% (TSA, p=0.02) with recurrences found in 8% (EP) vs 3.2% (TSA; p=0.07); reinterventions were more frequent in the EP group. Overall survival was comparable. Conclusions: The rate of patients with poor indications due to non-neoplastic disease or advanced cancer is still high for both EP and TSA; multiple retreatments were necessary for EP. Although EP can be considered an appropriate primary therapy for certain ampullary adenomas, case selection for both therapies (especially with regard to the best step-up approach) should be studied further. Competing Interests: Competing interests: MH: Honoraria from FUJIFILM for lectures and expert panel. Honoraria from Falk Foundation for lectures. MBruno: Boston Scientific: consultant (money to institution), support for industry and investigator-initiated studies. Cook Medical: consultant (money to institution), support for industry and investigator-initiated studies. Pentax Medical: consultant (money to institution), support for investigator-initiated studies. Mylan: lecturer, support for investigator-initiated studies. ChiRoStim: support for investigator-initiated studies.MDC received a research grant Boston from Haemonetics,INC and he is co-PI of a Boston Scientific sponsored study (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)
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