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

Elias Karam (1) , Marcus Hollenbach (2) , Einas Abou Ali , Francesco Auriemma , Aiste Gulla , Christian Heise , Sara Regner , Sébastien Gaujoux (3) , Jean-Marc Regimbeau (4, 5) , Georg Kähler , Steffen Seyfried , Jean Vaillant (6) , Charles de Ponthaud (3) , Alain Sauvanet (7) , David Birnbaum (8, 9) , Nicolas Regenet (10) , Stéphanie Truant (11) , Enrique Pérez-Cuadrado-Robles (12) , Matthieu Bruzzi , Renato Lupinacci (13) , Martin Brunel , Giulio Belfiori , Louise Barbier , Ephrem Salamé , Francois Souche , Lilian Schwarz , Laura Maggino , Roberto Salvia , Johan Gagniére , Marco del Chiaro , Galen Leung , Thilo Hackert , Tobias Kleemann , Woo Paik , Karel Caca , Ana Dugic , Steffen Muehldorfer , Brigitte Schumacher , David Albers

1 SAF - Laboratoire de Sciences Actuarielle et Financière
2 Leipzig University / Universität Leipzig
3 CHU Pitié-Salpêtrière [AP-HP]
4 Chirurgie digestive [CHU Amiens]
5 SSPC - Simplification des soins chez les patients complexes - UR UPJV 7518
6 Université des Antilles (Pôle Guadeloupe)
7 Hôpital Beaujon [AP-HP]
8 CRCM - Centre de Recherche en Cancérologie de Marseille
9 Hôpital Nord [CHU - APHM]
10 CHU Nantes - Centre Hospitalier Universitaire de Nantes
11 CHRU Lille - Centre Hospitalier Régional Universitaire [CHU Lille]
12 HEGP - Hôpital Européen Georges Pompidou [APHP]
13 Groupe Hospitalier Diaconesses Croix Saint-Simon

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.

Domaines: Médecine humaine et pathologie

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⟩