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Article Dans Une Revue Surgery Année : 2023

Outcomes of rescue procedures in the management of locally recurrent ampullary tumors: A Pancreas 2000/EPC study

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Einas Abou Ali
  • Fonction : Auteur
Francesco Auriemma
  • Fonction : Auteur
Aiste Gulla
Christian Heise
  • Fonction : Auteur
Sara Regner
Sébastien Gaujoux
Georg Kähler
  • Fonction : Auteur
Steffen Seyfried
Alain Sauvanet
Matthieu Bruzzi
  • Fonction : Auteur
Martin Brunel
  • Fonction : Auteur
Giulio Belfiori
  • Fonction : Auteur
Louise Barbier
Ephrem Salamé
  • Fonction : Auteur
Francois Souche
Lilian Schwarz
  • Fonction : Auteur
Laura Maggino
Roberto Salvia
  • Fonction : Auteur
Johan Gagniére
  • Fonction : Auteur
Marco del Chiaro
  • Fonction : Auteur
Galen Leung
  • Fonction : Auteur
Thilo Hackert
  • Fonction : Auteur
Tobias Kleemann
Woo Paik
  • Fonction : Auteur
Karel Caca
  • Fonction : Auteur
Ana Dugic
Steffen Muehldorfer
Brigitte Schumacher
  • Fonction : Auteur
David Albers
  • Fonction : Auteur

Résumé

Background: Ampullary lesions are rare and can be locally treated either with endoscopic papillectomy or transduodenal surgical ampullectomy. Management of local recurrence after a first-line treatment has been poorly studied. Methods: Patients with a local recurrence of an ampullary lesion initially treated with endoscopic papillectomy or transduodenal surgical ampullectomy were retrospectively included from a multi-institutional database (58 centers) between 2005 and 2018. Results: A total of 103 patients were included, 21 (20.4%) treated with redo endoscopic papillectomy, 14 (13.6%) with transduodenal surgical ampullectomy, and 68 (66%) with pancreaticoduodenectomy. Redo endoscopic papillectomy had low morbidity with 4.8% (n = 1) severe to fatal complications and a R0 rate of 81% (n = 17). Transduodenal surgical ampullectomy and pancreaticoduodenectomy after a first procedure had a higher morbidity with Clavien III and more complications, respectively, 28.6% (n = 4) and 25% (n = 17); R0 resection rates were 85.7% (n = 12) and 92.6% (n = 63), both without statistically significant difference compared to endoscopic papillectomy (P = .1 and 0.2). Pancreaticoduodenectomy had 4.4% (n = 2) mortality. No deaths were registered after transduodenal surgical ampullectomy or endoscopic papillectomy. Recurrences treated with pancreaticoduodenectomy were more likely to be adenocarcinomas (79.4%, n = 54 vs 21.4%, n = 3 for transduodenal surgical ampullectomy and 4.8%, n = 1 for endoscopic papillectomy, P < .0001). Three-year overall survival and disease-free survival were comparable. Conclusion: Endoscopy is appropriate for noninvasive recurrences, with resection rate and survival outcomes comparable to surgery. Surgery applies more to invasive recurrences, with transduodenal surgical ampullectomy rather for carcinoma in situ and early cancers and pancreaticoduodenectomy for more advanced tumors.
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Dates et versions

hal-03947035 , version 1 (19-01-2023)

Identifiants

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Elias Karam, Marcus Hollenbach, Einas Abou Ali, Francesco Auriemma, Aiste Gulla, et al.. Outcomes of rescue procedures in the management of locally recurrent ampullary tumors: A Pancreas 2000/EPC study. Surgery, 2023, ⟨10.1016/j.surg.2022.12.011⟩. ⟨hal-03947035⟩
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