Transduodenal ampullectomy provides a less invasive technique to cure early ampullary cancer.

Yang Gao,Xinyu Huang,Xiuyan Huang,Zhou Yuan,Hongcheng Wang,Yayun Zhu

doi:10.1186/s12893-016-0156-z

Yang Gao, Xinyu Huang + Show 4 more

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https://doi.org/10.1186/s12893-016-0156-z

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Abstract

BackgroundThe aim of this study was to evaluate the clinical efficiency of transduodenal ampullectomy (TDA) compared to conventional pancreatoduodenectomy (PD) in patients with early ampullary cancers.MethodsWe carried out a retrospective study by reviewing the medical records of 43 patients with early ampullary cancer who underwent either TDA or PD from January 2001 to December 2014. TDA and PD were performed on 22 patients and 21 patients, respectively. Clinical data, perioperative clinical outcomes and prognosis were evaluated. The median follow-up was 75 (range, 38–143) months.ResultsThe sensitivity of intraoperative frozen resection was 100 % (4/4) and 94.9 % (37/39) in patients with pTis and pT1 tumors compared to final histologic diagnoses. The 5-year survival rate of patients with early ampullary cancer was 77.3 % in TDA group and 75.9 % in PD group (P = 0.927). Patients with lymph node metastasis presented a shorter 5-year survival rate (P = 0.014). TDA was associated with lower surgical morbidity (P = 0.033), estimated blood loss (P = 0.002), medical cost (P = 0.028) compared to PD. No pancreatic fistula and surgical mortality occurred in TDA group.ConclusionsTDA could produce satisfactory clinical efficiency in patients fulfilled the following criteria simultaneously: pTis or pT1 stage, tumor size ≤ 2 cm, without lymph node metastasis. To achieve favorable outcomes, intraoperative frozen section examinations should be reliable and resection margins should be negative.

Highlights

The aim of this study was to evaluate the clinical efficiency of transduodenal ampullectomy (TDA) compared to conventional pancreatoduodenectomy (PD) in patients with early ampullary cancers
Of the 43 patients (24 male and 19 female) diagnosed as early tumor of the VA, 4 pTis tumors and 18 pT1 tumors were in TDA group and PD group only consisted of 21 pT1 tumors
No statistical difference was observed between TDA group and PD group regarding sex, age, clinical presentation, tumor size, carbohydrate antigen 19–9 (CA19-9), carcinoembryonic antigen (CEA)

Summary

Introduction

The aim of this study was to evaluate the clinical efficiency of transduodenal ampullectomy (TDA) compared to conventional pancreatoduodenectomy (PD) in patients with early ampullary cancers. TDA is a less invasive and simple technique, which could potentially provide equivalent clinical outcomes for early ampullary tumors compared to radical PD, while the indications for this local ampullectomy are still controversial. Lymphatic invasion, resection margin and depth of invasion were critical prognostic factors [6, 12]. To achieve satisfactory clinical outcomes of TDA, two criteria should be taken into consideration: no lymph node metastasis and negative resection margin [5, 6].

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