Evaluation of Additional Treatment for Residual Cases After Endoscopic Papillectomy of Duodenal Ampullary Tumors.
If endoscopic residuals are present after papillectomy, additional treatment is necessary; however, careful observation may be appropriate in selected cases without endoscopic residuals.
Where it sits
this study against the rest of the sermorelin corpusSummary and findings
This study evaluated the prognosis and outcomes of additional treatment for residual adenocarcinoma and adenoma following endoscopic papillectomy in 43 patients. The study found that among 12 cases of adenocarcinoma, 10 had pathological residuals, with four undergoing additional surgery but no cancer detected. Additionally, 31 cases of residual adenoma were identified, with recurrence in three cases managed endoscopically.
Abstract
<h4>Background and aims</h4>This study aimed to assess the prognosis and outcomes of additional treatment for residual adenocarcinoma and adenoma following endoscopic papillectomy (EP) for ampullary tumors.<h4>Methods</h4>Of 191 patients who underwent EP, 43 with adenocarcinoma or adenoma and either positive or unknown pathological margins were included. Cases with positive or unknown pathological margins and residuals on endoscopic observation after EP were defined as endoscopic residuals, and cases without endoscopic residuals were defined as pathological residuals. The outcomes between these groups were compared to evaluate additional treatment.<h4>Results</h4>A total of 12 cases of adenocarcinoma were identified, with pathological residuals in 10 cases and endoscopic residuals in two cases. Of the two cases with endoscopic residuals, one underwent additional surgical resection, while the other was observed and subsequently showed disease progression. Among the 10 cases with pathological residual adenocarcinoma, four underwent additional surgery, but no cancer was detected in the resected specimens. The remaining six cases showed no disease progression during the observation period, suggesting that pathological residual adenocarcinoma may have been completely eradicated by EP. Residual adenoma was detected in 31 cases, with pathological residuals in 20 cases and endoscopic residuals in 11 cases. Adenoma recurrence occurred in three cases, all of which were successfully managed with endoscopic treatment.<h4>Conclusions</h4>If the pathological margin is positive or unknown, additional treatment is necessary for cases with endoscopic residuals after EP. However, in the absence of endoscopic residuals, follow-up observation may be carefully considered in selected cases with caution.<h4>Trial registration</h4>N/A.
Background
This study addresses the outcomes of additional treatment for residual adenocarcinoma and adenoma after endoscopic papillectomy for ampullary tumors. Prior knowledge indicated that endoscopic papillectomy could leave residual tumors, but the necessity and effectiveness of further treatment were not well established. This study is significant as it evaluates the need for additional interventions based on the presence of residual disease.
Methods
The study included 43 patients with adenocarcinoma or adenoma and either positive or unknown pathological margins from an initial cohort of 191 patients who underwent endoscopic papillectomy. The outcomes were compared between those with endoscopic and pathological residuals. Additional treatments included surgical resection or observation.
Results
Among the 12 identified cases of adenocarcinoma, there were 10 cases with pathological residuals, and 2 with endoscopic residuals. One of the endoscopic residual cases underwent additional surgical resection, while the other showed disease progression. Of the 10 cases with pathological residuals, four underwent surgery with no cancer detected in the specimens.
Interpretation
The findings suggest that while additional treatment may be necessary for cases with endoscopic residuals, many cases of pathological residual adenocarcinoma may not require further intervention as they could be eradicated by the initial procedure. However, the small sample size and lack of a control group limit the strength of these conclusions, and further studies are needed to confirm these results.
Key findings
- 12 cases of adenocarcinoma identified, n=43.
- Pathological residuals in 10 cases of adenocarcinoma.
- Endoscopic residuals in 2 cases of adenocarcinoma.
- 4 out of 10 cases of pathological residual adenocarcinoma underwent additional surgery, no cancer detected.
- 31 cases of residual adenoma identified, n=43.
- Adenoma recurrence in 3 cases, all managed with endoscopic treatment.
Limitations
- small sample size n=43
- no control group
- observational study design
- potential selection bias