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Long-term outcomes of endoscopic papillectomy for ampullary adenoma with high-grade dysplasia or adenocarcinoma: a propensity score-matched analysis

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Abstract

Background

Evidence of endoscopic papillectomy (EP) for ampullar adenoma with high-grade dysplasia (HGD) or adenocarcinoma is insufficient. Here we investigated the long-term outcomes of the advanced ampullary tumors treated by EP with careful surveillance comparing to subsequent surgery after EP.

Methods

Patients treated with EP for ampullary adenoma with HGD or adenocarcinoma from the multi-center retrospective Korean cohort of ampulla of Vater tumor were categorized into EP alone versus EP with subsequent surgery groups. The overall survival (OS) and recurrence-free survival (RFS) were analyzed for unmatched and matched cohorts using propensity score with nearest neighbor method.

Results

During a median 43.3 months of follow-up, 5-year OS was not significantly different between the EP alone and EP surgery groups (91.9% vs. 82.3%, P = 0.443 for unmatched cohort; 89.2% vs. 82.3%, P = 0.861 for matched cohort, respectively). Furthermore, 5-year RFS was not significantly different between the two groups (82.1% vs. 86.7%, P = 0.520 for unmatched cohort; 66.1% vs. 86.7%, P = 0.052 for matched cohort, respectively). However, the patients with positive both (lateral and deep) margins showed significantly poorer survival outcomes than those with negative margins within the EP alone group (P = 0.007).

Conclusion

EP alone with careful surveillance showed comparable survival outcomes to those of EP with subsequent surgery for ampullar HGD or adenocarcinoma. Resection margin status could be a parameter to determine whether to perform subsequent radical surgery after EP.

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Acknowledgements

The authors thank the Korean Society of Gastrointestinal Research for allowing us to use the clinical data of the South Korean cohort for AoV tumors.

Funding

This study was supported by a grant from the Korean Society of Gastrointestinal Cancer Research (2021).

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Author notes

  1. Seung Bae Yoon and Min Kyu Jung have contributed equally to this work as first authors.

Authors and Affiliations

  1. Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea

    Seung Bae Yoon

  2. Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea

    Min Kyu Jung

  3. Department of Internal Medicine, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Republic of Korea

    Yoon Suk Lee

  4. Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea

    Joo Kyung Park

  5. Department of Internal Medicine, Seoul Metropolitan Government Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea

    Dong Kee Jang

  6. Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea

    Jae Min Lee

  7. Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea

    Hee Seung Lee

  8. Department of Internal Medicine, Hallym University College of Medicine, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea

    Dong Woo Shin

  9. Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea

    Jong-Chan Lee & Jin-Hyeok Hwang

  10. Division of Gastroenterology, Department of Internal Medicine, Ilsan Paik Hospital, Inje University College of Medicine, Juhwa-ro 170, Ilsan Seogu, Goyang, 10380, South Korea

    Yoon Suk Lee

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Contributions

Study concept and design: SBY, MKJ, YSL, and JHH. Data acquisition: SBY, MKJ, YSL, JKP, DKJ, JML, HSL, DWS, and JCL. Data analysis and interpretation: SBY, MKJ, and YSL. Drafting of the manuscript: SBY and YSL. Critical revision of the manuscript for important intellectual content: MKJ and JJH. Statistical analysis: SBY and YSL. Obtained funding: JJH. Administrative, technical, or material support: JKP, DKJ, JML, HSL, and JCL. Study supervision: MKJ, JKP, and JHH. Approval of final manuscript: all authors.

Corresponding author

Correspondence to Yoon Suk Lee.

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Disclosure

Seung Bae Yoon, Min Kyu Jung, Yoon Suk Lee, Joo Kyung Park, Dong Kee Jang, Jae Min Lee, Hee Seung Lee, Dong Woo Shin, Jong-Chan Lee, and Jin-Hyeok Hwang have no conflict of interest or financial ties to disclose.

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Supplementary file1 (DOCX 23 KB)

464_2022_9856_MOESM2_ESM.tif

For patients with ampullary AC, OS (A) and RFS (B) between EP alone and EP surgery group. EP, endoscopic papillectomy; OS, overall survival; RFS, recurrence-free survival. Supplementary file2 (TIF 2087 KB)

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Yoon, S.B., Jung, M.K., Lee, Y.S. et al. Long-term outcomes of endoscopic papillectomy for ampullary adenoma with high-grade dysplasia or adenocarcinoma: a propensity score-matched analysis. Surg Endosc 37, 3522–3530 (2023). https://doi.org/10.1007/s00464-022-09856-w

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