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

Seung-Soo Hong,Jae-Do Yang,Youngmok Park,Hee-Joon Kim,Keun-Soo Ahn,Young-Hoon Roh,Seung-Eun Lee,Wooil Kwon,Seog-Ki Min,Jin-Seok Heo,Ju-Ik Moon,Sung-Sik Han,Ho-Kyoung Hwang,Joon-Seong Park,Chi-Young Jeong,Sang-Geol Kim,Jin-Young Jang,Chol-Kyoon Cho

doi:10.3390/cancers13092038

Abstract

Simple SummaryThis 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 2000 to 2019 were collected from 15 institutions. A total of 486 patients were enrolled (PPPD, 418; TDA, 68). The oncologic behavior (tumor size, T stage, differentiation, lymphovascular invasion) in the PPPD group was more aggressive than that in the TDA group at all T stages. The 5-year disease-free survival and overall survival did not differ between the two groups when considering all T stages or only the Tis + T1 group. In T1 patients, PPPD had survival outcomes superior to those in the TDA group. In the TDA group, lymph node dissection did not affect survival. In conclusion, PPPD should be the standard procedure for early AoV cancer.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 (p = 0.034), advanced T stage (p < 0.001), aggressive cell differentiation (p < 0.001), and more lymphovascular invasion (p = 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%, p = 0.040) and superior OS (PPPD vs. TDA, 89.1% vs. 68.0%, p = 0.056) than TDA. Lymph node dissection (LND) in the TDA group did not affect DFS or OS (TDA + LND vs. TDA-only, DFS, p = 0.784; OS, p = 0.870). In conclusion, PPPD should be the standard procedure for early AoV cancer.

Highlights

Ampulla of Vater (AoV) cancer is a malignant neoplasm that develops from the ampulla of Vater complex, which lies between the area distal to the confluence of the pancreatic duct and the distal common bile duct (CBD) and the duodenal opening
Clinicopathologic Characteristics of the pylorus-preserving pancreatoduodenectomy (PPPD) and transduodenal ampullectomy (TDA) Groups according to T Stage
Tumor size was significantly larger in the PPPD group than in the TDA group (1.91 ± 1.02 vs. 1.62 ± 0.79 cm, p = 0.034)

Summary

Introduction

Ampulla of Vater (AoV) cancer is a malignant neoplasm that develops from the ampulla of Vater complex, which lies between the area distal to the confluence of the pancreatic duct and the distal common bile duct (CBD) and the duodenal opening. AoV cancer is a rare disease that constitutes roughly 7% of peri-ampullary tumors [1,2]. Half of patients with AoV cancer present at an advanced stage. For those who present at an early stage, pancreaticoduodenectomy (PD) or pylorus-preserving pancreaticoduodenectomy (PPPD) are recognized as standard treatments [6,7,8]. Because the disease generally presents in patients whose age makes surgical procedures risky, only 40% of AoV patients undergo surgical resection [9]

Results

Discussion

Conclusion