Can endoscopic papillectomy be curative for early ampullary adenocarcinoma of the ampulla of Vater?
Can endoscopic papillectomy be curative for early ampullary adenocarcinoma of the ampulla of Vater?
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DOI：
10.1007/s00464-016-5141-1
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发表时间：
2017-04-01
影响因子：
3.1
通讯作者：
Napoleon, Bertrand
中科院分区：
文献类型：
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作者：
Alvarez-Sanchez, Maria-Victoria;Oria, Ines;Napoleon, Bertrand
背景：内窥镜乳头切除术(EP)对早期壶腹癌(AC)的治疗作用仍存在争议。本研究的目的是评估EP对早期AC的治疗潜力，并确定淋巴转移(LNMs)的预测因素。方法我们回顾了1999年至2013年间前瞻性纳入数据库的173例接受EP的患者。28例切除标本中有腺癌。对于十二指肠黏膜下浸润、导管内生、R1切除或淋巴血管侵犯的病例，建议附加手术。结果28例中有16例十二指肠黏膜下侵犯，9例十二指肠黏膜下侵犯。胆胰亚型的ACS较小(NS)；100%有粘膜下侵犯，71%有LNMS。较小的肿瘤大小、胆胰管亚型和黏膜下侵犯与淋巴结转移显著相关(p<；0.028、p<；0.028和p<；0.014)。在多因素分析中，淋巴结转移的预测因素是黏膜下侵犯和肿瘤大小(OR 0.032，p<；0.023和OR 0.711，p<；0.035)。结论EP对仅局限于十二指肠粘膜或Oddi括约肌但无淋巴管侵犯的AC患者是有效的。由于诊断时存在更多的侵袭性分期，EP可能不能治愈胆胰管亚型的急性冠脉综合征。肿瘤大小的重要性受到其他混杂因素的限制，如组织学亚型。
Background The therapeutic role of endoscopic papillectomy (EP) for early ampullary cancer (AC) is still controversial. The aim of the present study was to evaluate the curative potential of EP for early AC and to identify predictors of lymph node metastases (LNMs).Methods We retrospectively reviewed 173 patients who were prospectively included in a database and who underwent EP between 1999 and 2013. Adenocarcinoma was present in 28 resected specimens. An additional surgery was proposed in cases of duodenal submucosal infiltration, duct ingrowth, R1 resection or lymphovascular invasion. Clinicopathological information and outcomes were collected, and predictors of LNMs were evaluated.Results Duodenal submucosal invasion was present in 16/28 cases and LNMs, in 9/28 cases. ACs of the biliopancreatic subtype were smaller (NS); 100 % had submucosal invasion, and 71 % had LNMs. Smaller tumour size, biliopancreatic subtype and submucosal invasion were significantly correlated with LNMs (p < 0.028, p < 0.028 and p < 0.014). Predictive factors of LNMs in the multivariate analysis were submucosal invasion and tumour size (OR 0.032, p < 0.023 and OR 0.711, p < 0.035). EP was curative in 100 % of cancers with R0 resection and no evidence of submucosal or lymphovascular invasion.Conclusion EP may be curative for patients with AC limited to the duodenal mucosa or the sphincter of Oddi without lymphovascular invasion. Due to the presence of more invasive stages at diagnosis, EP may not be curative for ACs of the biliopancreatic subtype. The significance of tumour size is limited by other confounders, such as the histological subtype.