期刊
JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY
卷 36, 期 8, 页码 2315-2323出版社
WILEY
DOI: 10.1111/jgh.15462
关键词
Adenocarcinoma; Duodenal ampullary tumor; Endoscopic papillectomy; Pancreaticoduodenectomy
资金
- National Research Foundation of Korea (NRF) - Korea government (MSIT) [2020R1A2C2003604]
- MSIT: Ministry of Science and ICT
- National Research Foundation of Korea [2020R1A2C2003604] Funding Source: Korea Institute of Science & Technology Information (KISTI), National Science & Technology Information Service (NTIS)
The study showed that endoscopic papillectomy followed by endoscopic surveillance had long-term outcomes comparable to surgical resection for early ampullary cancer, providing a potential curative alternative for incidentally found early-stage ampullary cancer, especially in patients not suitable for or refusing radical surgery. No significant differences were observed between patient groups in tumor characteristics and clinical outcomes.
Background and Aim While recent evidences support endoscopic resection as curative in ampullary tumors with high-grade intraepithelial neoplasia, only small case series have reported endoscopic management of early-stage ampullary cancer; thus, radical surgery remains the only accepted treatment modality. We evaluated the long-term outcomes of early ampullary adenocarcinoma administered endoscopic management. Methods We retrospectively reviewed electronic medical records of 715 patients undergoing endoscopic papillectomy (EP) in a single tertiary medical center in Korea in 2004-2016. We included patients incidentally diagnosed with early-stage adenocarcinoma (Tis and T1a, American Joint Committee on Cancer 8th edition) after EP and with >2 years of follow-up data and analyzed their demographics, histopathologic data, and clinical outcomes. Results Among 70 total patients in the EP-alone (n = 42) and subsequent surgery (n = 28) groups, we observed no significant differences in demographics or tumor size (2.0 +/- 0.6 vs 1.9 +/- 0.5 cm, P = 0.532), histologic grade (P = 0.077), tumor extent (P = 1.000), lymphovascular invasion (2.4% vs 10.7%, P = 0.344), or complete resection rates (57.1% vs 57.1%, P = 1.000) between groups. Adenocarcinoma lesions were larger in the subsequent surgery group (0.7 +/- 0.5 vs 1.1 +/- 0.7 cm, P = 0.002). The EP-alone group received more additional ablative treatment (42.9% vs 14.3%, P = 0.024). The 5-year disease-free and cancer-free survival rates were 79.1% vs 87.4% (P = 0.111) and 93.5% versus 87.4% (P = 0.726), respectively, and did not differ significantly between groups. Conclusions Endoscopic papillectomy followed by endoscopic surveillance showed long-term outcomes comparable with surgical resection for early ampullary cancer and maybe curable alternative to surgery for incidentally found early-stage ampullary cancer, especially in patients unfit for or refusing radical surgery.
作者
我是这篇论文的作者
点击您的名字以认领此论文并将其添加到您的个人资料中。
推荐
暂无数据