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Is endoscopic papillectomy safe for ampullary adenomas with high-grade dysplasia?

Kim, JH; Han, JH; Yoo, BM; Kim, MW; Kim, WH
Annals of surgical oncology, 16(9):2547-2554, 2009
Journal Title
Annals of surgical oncology
OBJECTIVES: This study was designed to provide safe management guidelines for ampullary adenoma by analysis of clinicopathological features.

BACKGROUND: The treatment of ampullary cancer has been established; however, the indications for treatment of ampullary adenoma remain controversial.

METHODS: Between July 1997 and July 2008, a total of 33 patients were diagnosed with ampullary adenoma prior to procedures: 20 endoscopic papillectomies (ESP), 5 transduodenal resections (TDR), and 8 pancreatoduodenectomies (PD).

RESULTS: The false-negative rate of biopsy for cancer was 27.5% (8/29). Coexistence of cancer in patients with pre-high-grade dysplasia (HGD) was 50.0% (5/10), whereas it was 15.7% in pre-low-grade dysplasia (LGD). In addition, the rate of recurrence was 80% (8/10) in patients with pre-HGD. The size of tumor by final pathology was 1.27 +/- 0.89 cm in LGD, 1.81 +/- 0.99 cm in HGD, and 1.98 +/- 1.08 cm in cancer group. There was a significant correlation between size of tumor and final pathology (P = 0.036). According to receiver operating characteristic (ROC) curve, criterion to predict HGD/cancer was tumor size larger than 1.5 cm; sensitivity and specificity were 55.6% and 80.0%, respectively, and likelihood ratio was 2.778. However, size of tumor was not associated with preprocedural pathology.

CONCLUSIONS: Ampullary adenoma with preprocedural HGD was highly associated with coexistence of cancer and recurrence. Moreover, most of large tumors were treated by surgical procedures and proved to be cancer. Therefore, we suggest that ampullary adenoma with preprocedural HGD or more than 1.5 cm should not be managed with endoscopic papillectomy due to high associated rates of recurrence.
MeSH terms
Adenoma/pathologyAdenoma/surgery*AgedAmpulla of Vater/pathologyAmpulla of Vater/surgery*Common Bile Duct Neoplasms/pathologyCommon Bile Duct Neoplasms/surgery*Endoscopy, Gastrointestinal*FemaleFollow-Up StudiesHumansMaleMiddle AgedNeoplasm Recurrence, Local/pathologyNeoplasm Recurrence, Local/surgeryNeoplasm StagingPancreaticoduodenectomyPrognosisSurvival Rate
Appears in Collections:
Journal Papers > School of Medicine / Graduate School of Medicine > Surgery
Journal Papers > School of Medicine / Graduate School of Medicine > Gastroenterology
Journal Papers > School of Medicine / Graduate School of Medicine > Pathology
AJOU Authors
김, 지훈김, 진홍한, 재호유, 병무김, 명욱김, 욱환
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