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Trans-duodenal ampullectomy for ampullary neoplasms: early and long-term outcomes in 36 consecutive patients

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Abstract

Background

Trans-duodenal ampullectomy (TDA) is a surgical option for the treatment of selected ampullary neoplasms. The aim of this study was to evaluate our experience with TDA for the treatment of ampullary neoplasms, focusing on indications, technical aspects, and short- and long-term outcomes.

Methods

All TDAs for ampullary neoplasms performed between January 2010 and December 2018 at our institution were retrospectively evaluated. Patients had ampullary neoplasms with low-grade dysplasia or in situ carcinoma (Tis) not suitable for an endoscopic approach, ampullary carcinoma unfit for pancreaticoduodenectomy (PD), or ampullary neuroendocrine G1-tumours.

Results

Thirty-six patients were included in the study: 9 (25.0%) with neoplasms with low-grade dysplasia, 4 (11.1%) with G1 neuroendocrine tumours and 23 (63.9%) with Tis or invasive carcinoma. Mean operative time was 252.5 min. Overall and severe (Clavien–Dindo > IIIa) morbidity rate was 44.4% and 13.9%, respectively. No 90-day mortality was observed. At follow-up, no deaths were observed and local recurrence rate was 11.1% for patients with ampullary adenomas with low-grade dysplasia. Among four patients with neuroendocrine neoplasms, only one developed recurrence (pulmonary). Tis, T1 and T2 lesions were found in 16 (69.6%), 2 (8.7%) and 5 (21.7%) patients, respectively: recurrence occurred in 3 patients with Tis lesions (one malignant), no patients with T1 neoplasms and 2 patients with T2 lesions (3 patients had a survival of > 3 years).

Conclusions

TDA is a feasible and effective surgical procedure for the treatment of ampullary adenomas with low-grade dysplasia when endoscopic approach is contraindicated or has failed. For lesions with evidence of malignancy, TDA seems to be an oncological safe procedure for Tis ampullary cancer and a good palliative procedure for patients unfit for PD. Moreover, TDA may be appropriate for the treatment of G1 ampullary neuroendocrine neoplasms. A large multicentre study of TDA for early ampullary cancers is needed.

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Authors and Affiliations

  1. Pancreatic Surgery Unit, Humanitas Clinical and Research Center – IRCCS, Alessandro Manzoni 56, Rozzano, 20089, Milan, Italy

    Gennaro Nappo, Damiano Gentile, Jacopo Galvanin, Giovanni Capretti, Cristina Ridolfi, Francesca Gavazzi & Alessandro Zerbi

  2. Public Health and Statistics, Campus Bio-Medico University of Rome, Rome, Italy

    Tommasangelo Petitti

  3. Pathology Department, Humanitas Clinical and Research Center – IRCCS, Rozzano, Milan, Italy

    Paola Spaggiari

  4. Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Clinical and Research Cancer Center – IRCCS, Rozzano, Milan, Italy

    Silvia Carrara & Alessandro Repici

  5. Humanitas University, Rozzano, Milan, Italy

    Alessandro Repici & Alessandro Zerbi

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  1. Gennaro Nappo
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Correspondence to Gennaro Nappo.

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Gennaro Nappo, Damiano Gentile, Jacopo Galvanin, Giovanni Capretti, Cristina Ridolfi, Tommasangelo Petitti, Paola Spaggiari, Silvia Carrara, Francesca Gavazzi, Alessandro Repici and Alessandro Zerbi have nothing to disclose.

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Nappo, G., Gentile, D., Galvanin, J. et al. Trans-duodenal ampullectomy for ampullary neoplasms: early and long-term outcomes in 36 consecutive patients. Surg Endosc 34, 4358–4368 (2020). https://doi.org/10.1007/s00464-019-07206-x

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