Abstract
Endoscopic papillectomy is widely used for the curative treatment of ampulla of Vater tumors replacing surgical resection. However, there are scarce data on the treatment outcome in tumors with high-grade adenoma or early adenocarcinoma. The aim of this study was to evaluate the outcome after endoscopic papillectomy of ampullary tumor with high-grade adenoma or early adenocarcinoma. From January 2005 to December 2018, all the patients underwent endoscopic papillectomy as an initial curative treatment for ampullary high-grade adenoma or early adenocarcinoma at Seoul National University Hospital were retrospectively reviewed. All the patients were recommended to undergo subsequent surgical resection and patients who refused to undergo surgery were followed at 1 month with endoscopy. If residual tumor was identified at follow-up endoscopy, it was considered as incomplete resection, and progression free survival of patients without incomplete resection was evaluated. A total of 230 endoscopic papillectomy were performed during study period. Among them, 80 were high-grade adenoma or adenocarcinoma (46 high-grade adenoma and 34 adenocarcinoma) and were eligible to the study. One patient with adenocarcinoma was died after the procedure related complication (massive hemorrhage). Within 1 month after the procedure, 13 patients received subsequent surgical resection and presence of residual tumor on surgical specimen was 9 of 13 (69.2%). 21 patients had residual tumor on follow up endoscopy (incomplete resection rate of 35%) and 5 patients were lost to follow up. Among patients without incomplete resection (n = 40), tumor was recurred in 13 patients during the follow-up period and the median progression-free survival was 963 days (95% confidence interval, 525–N/A). Incomplete resection rate and probability of remaining tumor in surgical specimen were remarkably high after the endoscopic papillectomy of ampullary high-grade adenoma or early adenocarcinoma. In addition, tumors recurred frequently in long-term follow-up even after the complete resection. Endoscopic papillectomy should be cautiously applied in ampullary tumor with high-grade adenoma or early adenocarcinoma.
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