Endoscopic and Surgical Management of Non-Metastatic Ampullary Neuroendocrine Neoplasia: A Multi-Institutional Pancreas2000/EPC Study
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Published:2023-06-27
Issue:
Volume:
Page:1-11
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ISSN:0028-3835
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Container-title:Neuroendocrinology
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language:en
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Short-container-title:Neuroendocrinology
Author:
Karam EliasORCID, Hollenbach Marcus, Abou Ali Einas, Auriemma Francesco, Anderloni AndreaORCID, Barbier Louise, Belfiori Giulio, Caillol Fabrice, Crippa Stefano, Del Chiaro Marco, De Ponthaud CharlesORCID, Dahel YanisORCID, Falconi MassimoORCID, Giovannini Marc, Heling Dominik, Inoue Yosuke, Jarnagin William R., Leung GalenORCID, Lupinacci Renato M., Mariani Alberto, Masaryk Viliam, Miksch Rainer Christoph, Musquer Nicolas, Napoleon Bertrand, Oba Atsushi, Partelli Stefano, Petrone Maria C., Prat Frédéric, Repici Alessandro, Sauvanet AlainORCID, Salzmann Katrin, Schattner Mark A., Schulick Richard, Schwarz LilianORCID, Soares Kevin, Souche François R., Truant Stéphanie, Vaillant Jean C., Wang Tiegong, Wedi Edris, Werner Jens, Weismüller Tobias J.ORCID, Wichmann Dörte, Will Uwe, Zaccari PieraORCID, Gulla Aiste, Heise Christian, Regner SaraORCID, Gaujoux SébastienORCID,
Abstract
<b><i>Introduction:</i></b> Ampullary neuroendocrine neoplasia (NEN) is rare and evidence regarding their management is scarce. This study aimed to describe clinicopathological features, management, and prognosis of ampullary NEN according to their endoscopic or surgical management. <b><i>Methods:</i></b> From a multi-institutional international database, patients treated with either endoscopic papillectomy (EP), transduodenal surgical ampullectomy (TSA), or pancreaticoduodenectomy (PD) for ampullary NEN were included. Clinical features, post-procedure complications, and recurrences were assessed. <b><i>Results:</i></b> 65 patients were included, 20 (30.8%) treated with EP, 19 (29.2%) with TSA, and 26 (40%) with PD. Patients were mostly asymptomatic (<i>n</i> = 46; 70.8%). Median tumor size was 17 mm (12–22), tumors were mostly grade 1 (70.8%) and pT2 (55.4%). Two (10%) EP resulted in severe American Society for Gastrointestinal Enterology (ASGE) adverse post-procedure complications and 10 (50%) were R0. Clavien 3–5 complications did not occur after TSA and in 4, including 1 postoperative death (15.4%) of patients after PD, with 17 (89.5%) and 26 R0 resection (100%), respectively. The pN1/2 rate was 51.9% (<i>n</i> = 14) after PD. Tumor size larger than 1 cm (i.e., pT stage >1) was a predictor for R1 resection (<i>p</i> < 0.001). Three-year overall survival and disease-free survival after EP, TSA, and PD were 92%, 68%, 92% and 92%, 85%, 73%, respectively. <b><i>Conclusion:</i></b> Management of ampullary NEN is challenging. EP should not be performed in lesions larger than 1 cm or with a endoscopic ultrasonography T stage beyond T1. Local resection by TSA seems safe and feasible for lesions without nodal involvement. PD should be preferred for larger ampullary NEN at risk of nodal metastasis.
Subject
Cellular and Molecular Neuroscience,Endocrine and Autonomic Systems,Endocrinology,Endocrinology, Diabetes and Metabolism
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