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Shyr BS, Wang SE, Chen SC, Shyr YM, Shyr BU. Survival and surgical outcomes of robotic versus open pancreatoduodenectomy for ampullary cancer: A propensity score-matching comparison. Asian J Surg 2024; 47:899-904. [PMID: 37925285 DOI: 10.1016/j.asjsur.2023.10.076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 09/06/2023] [Accepted: 10/20/2023] [Indexed: 11/06/2023] Open
Abstract
BACKGROUND/OBJECTIVE Robotic pancreaticoduodenectomy in ampullary cancer has never been studied. This study aimed to clarify the feasibility and justification of robotic pancreaticoduodenectomy in ampullary cancer in terms of surgical risks, and oncologic and survival outcomes. METHODS A propensity score-matching comparison of robotic and open pancreaticoduodenectomy based on seven factors commonly used to predict the survival outcomes in ampullary cancer patients. RESULTS A total of 147 patients were enrolled, of which 101 and 46 underwent robotic and open pancreaticoduodenectomies, respectively. After propensity score-matching with a 2:1 ratio, 88 and 44 patients in the robotic and open pancreaticoduodenectomy groups were included. The operation time was of no significant difference after matching. The median intraoperative blood loss was much less in those who underwent robotic pancreaticoduodenectomy, both before (median, 120 vs. 320 c.c. P < 0.001) and after (100 vs. 335 mL P < 0.001) score-matching. There were no significant differences in terms of surgical risks, including surgical mortality, surgical morbidity, Clavien-Dindo severity classification, postoperative pancreatic fistula, delayed gastric emptying, post-pancreatectomy hemorrhage, chyle leak, bile leak, and wound infection, both before or after score-matching. The survival outcomes were also similar between the two groups, regardless of matching. CONCLUSIONS Robotic pancreaticoduodenectomy for ampullary cancer is not only technically feasible and safe without increasing surgical risks, but also oncologically justifiable without compromising surgical radicality and survival outcomes.
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Affiliation(s)
- Bor-Shiuan Shyr
- Division of General Surgery, Departments of Surgery, Taipei Veterans General Hospital, Taiwan, ROC; National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Shin-E Wang
- Division of General Surgery, Departments of Surgery, Taipei Veterans General Hospital, Taiwan, ROC; National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Shih-Chin Chen
- Division of General Surgery, Departments of Surgery, Taipei Veterans General Hospital, Taiwan, ROC; National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Yi-Ming Shyr
- Division of General Surgery, Departments of Surgery, Taipei Veterans General Hospital, Taiwan, ROC; National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Bor-Uei Shyr
- Division of General Surgery, Departments of Surgery, Taipei Veterans General Hospital, Taiwan, ROC; National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC.
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Duan Z, Zhang Y, Tang Y, Gao R, Bao J, Liang B. Adjuvant therapy for periampullary carcinoma and the significance of histopathological typing: A systematic review. Transl Oncol 2022; 20:101414. [PMID: 35397420 PMCID: PMC9006738 DOI: 10.1016/j.tranon.2022.101414] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 03/24/2022] [Accepted: 03/30/2022] [Indexed: 12/19/2022] Open
Abstract
The efficacy of adjuvant therapy for periampullary carcinoma is controversial. There is a trend of classification periampullary carcinoma into PB-type and IN-type, and the prognosis of different subtypes may be significantly different. The PB-type patients who accepted gemcitabine based chemotherapy and IN-type patients who accepted 5-FU based chemotherapy, maybe improved the prognosis. Chemoradiotherapy appears to be more effective in patients with advanced stages. There are few related studies on targeted therapy and immunotherapy, and further research is needed.
Objective This review investigates the role of adjuvant therapy (AT) and the importance of histopathological typing in periampullary carcinoma (PAC) treatment. Background PAC is a relatively rare gastrointestinal malignancy. The regimen and effect of AT in PAC are still controversial. However, there is a treatment based on histopathological types (pancreaticobiliary-type, PB-type or intestinal-type, IN-type), but there are no clear guidelines indicating that typing can be used to guide the selection of AT drugs. Methods A literature search of PubMed and Web of Science databases was conducted for studies published from January 2001 to August 2021 on the use of AT in PAC. Results A total of 75 studies were included in this review. According to existing studies, AT for PAC is mostly based on 5-FU or gemcitabine, but the effect is unknown. However, when PAC is classified into different histopathological types, AT with gemcitabine is beneficial for patients with the PB-type of PAC, while 5-FU-based AT is beneficial for patients with the IN-type of PAC. In addition, the benefits of AT are more pronounced in patients with a high-risk disease, such as patients with stage II/III, T3/T4 tumors, or positive lymph node involvement. There are few studies on targeted therapy and immunotherapy for PAC. Conclusions This review suggests that AT has potential survival benefits, especially when based on the histopathologic type that helps the choice of drugs during AT in PAC patients.
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Affiliation(s)
- Zhiqing Duan
- Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yinuo Zhang
- Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yajie Tang
- Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Ruqing Gao
- Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Jing Bao
- Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Bo Liang
- Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China.
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Fernandez-Placencia RM, Montenegro P, Guerrero M, Serrano M, Ortega E, Bravo M, Huanca L, Bertani S, Trejo JM, Webb P, Malca-Vasquez J, Taxa L, Lachos-Davila A, Celis-Zapata J, Luque-Vasquez C, Payet E, Ruiz E, Berrospi F. Survival after curative pancreaticoduodenectomy for ampullary adenocarcinoma in a South American population: A retrospective cohort study. World J Gastrointest Surg 2022; 14:24-35. [PMID: 35126860 PMCID: PMC8790327 DOI: 10.4240/wjgs.v14.i1.24] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 09/28/2021] [Accepted: 01/13/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Ampullary adenocarcinoma (AAC) is a rare neoplasm that accounts for only 0.2% of all gastrointestinal cancers. Its incidence rate is lower than 6 cases per million people. Different prognostic factors have been described for AAC and are associated with a wide range of survival rates. However, these studies have been exclusively conducted in patients originating from Asian, European, and North American countries. AIM To evaluate the histopathologic predictors of overall survival (OS) in South American patients with AAC treated with curative pancreaticoduodenectomy (PD). METHODS We analyzed retrospective data from 83 AAC patients who underwent curative (R0) PD at the National Cancer Institute of Peru between January 2010 and October 2020 to identify histopathologic predictors of OS. RESULTS Sixty-nine percent of patients had developed intestinal-type AAC (69%), 23% had pancreatobiliary-type AAC, and 8% had other subtypes. Forty-one percent of patients were classified as Stage I, according to the AJCC 8th Edition. Recurrence occurred primarily in the liver (n = 8), peritoneum (n = 4), and lung (n = 4). Statistical analyses indicated that T3 tumour stage [hazard ratio (HR) of 6.4, 95% confidence interval (CI) of 2.5-16.3, P < 0.001], lymph node metastasis (HR: 4.5, 95%CI: 1.8-11.3, P = 0.001), and pancreatobiliary type (HR: 2.7, 95%CI: 1.2-6.2, P = 0.025) were independent predictors of OS. CONCLUSION Extended tumour stage (T3), pancreatobiliary type, and positive lymph node metastasis represent independent predictors of a lower OS rate in South American AAC patients who underwent curative PD.
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Affiliation(s)
| | - Paola Montenegro
- Department of Medical Oncology, Instituto Nacional de Enfermedades Neoplasicas, Lima 15038, Peru
| | - Melvy Guerrero
- Department of Pathology, Instituto Nacional de Enfermedades Neoplasicas, Lima 15038, Peru
| | - Mariana Serrano
- Department of Medical Oncology, Instituto Nacional de Enfermedades Neoplasicas, Lima 15038, Peru
| | - Emperatriz Ortega
- Department of Medical Oncology, Instituto Nacional de Enfermedades Neoplasicas, Lima 15038, Peru
| | - Mercedes Bravo
- Department of Pathology, Instituto Nacional de Enfermedades Neoplasicas, Lima 15038, Peru
| | - Lourdes Huanca
- Department of Pathology, Instituto Nacional de Enfermedades Neoplasicas, Lima 15038, Peru
| | - Stéphane Bertani
- International Joint Laboratory of Molecular Anthopological Oncology, Instituto Nacional de Enfermedades Neoplasicas, Lima 15038, Peru
- Unite Pharmacochim & Pharmacol Dev, UMR152, F-31062 Toulouse, France
| | - Juan Manuel Trejo
- Department of Radiation Oncology, Instituto Nacional de Enfermedades Neoplasicas, Lima 15038, Peru
| | - Patricia Webb
- Department of Pathology, Instituto Nacional de Enfermedades Neoplasicas, Lima 15038, Peru
| | - Jenny Malca-Vasquez
- Department of Radiation Oncology, Instituto Nacional de Enfermedades Neoplasicas, Lima 15038, Peru
| | - Luis Taxa
- Department of Pathology, Instituto Nacional de Enfermedades Neoplasicas, Lima 15038, Peru
| | - Alberto Lachos-Davila
- Department of Radiation Oncology, Instituto Nacional de Enfermedades Neoplasicas, Lima 15038, Peru
| | - Juan Celis-Zapata
- Hepato-Pancreato-Biliary Section, Department of Abdominal Surgery, Instituto Nacional de Enfermedades Neoplasicas, Lima 15038, Peru
| | - Carlos Luque-Vasquez
- Department of Abdominal Surgery, Instituto Nacional de Enfermedades Neoplasicas, Lima 15038, Peru
| | - Eduardo Payet
- Department of Abdominal Surgery, Instituto Nacional de Enfermedades Neoplasicas, Lima 15038, Peru
| | - Eloy Ruiz
- Hepato-Pancreato-Biliary Section, Department of Abdominal Surgery, Instituto Nacional de Enfermedades Neoplasicas, Lima 15038, Peru
| | - Francisco Berrospi
- Hepato-Pancreato-Biliary Section, Department of Abdominal Surgery, Instituto Nacional de Enfermedades Neoplasicas, Lima 15038, Peru
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Quero G, Fiorillo C, De Sio D, Laterza V, Menghi R, Cina C, Schena CA, Rosa F, Galiandro F, Alfieri S. The role of mesopancreas excision for ampullary carcinomas: a single center propensity-score matched analysis. HPB (Oxford) 2021; 23:1557-1564. [PMID: 33933343 DOI: 10.1016/j.hpb.2021.03.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 03/10/2021] [Accepted: 03/23/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Few evidences are available on the prognostic role of mesopancreas excision(MPe) for ampullary cancers(ACs). Aim of this study was to compare the long-term outcomes between pancreaticoduodenectomy(PD) with(PD-MPe group) and without(sPD group) MP. METHODS Thirty-seven sPDs were matched and compared to 37 PD-MPes for perioperative outcomes, recurrence rate, disease-free(DFS) and overall survival(OS). RESULTS The PD-MPe technique related to a significantly higher number of harvested lymph nodes[16 (±6)] as compared to the sPD [10 (±5); p < 0.0001]. Tumor recurrence was more frequent in the sPD cohort[21 (56.8%) vs 12 (32.4%) in the PD-MPe population; p = 0.03]. Although not statistically different, PD-MPe was associated with a better DFS(40% vs 35.7% for sPD; p = 0.08) and OS(59.3% vs 39.1% for sPD; p = 0.07). At the multivariate analysis, a higher number of lymph nodes retrieved and a more extensive lymphovascular clearance reached with the MPe technique, together with lymph nodes metastases, were recognized as independent prognostic factors for a worse OS and DFS. CONCLUSION The PD-MPe technique is associated with a better oncological radicality thanks to the higher number of retrieved lymph nodes and to the more appropriate tumor clearance. This reflects in a lower incidence of tumor relapse and in improved outcomes in terms of OS and DFS.
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Affiliation(s)
- Giuseppe Quero
- Pancreatic Surgery Center, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy; CRMPG (Advanced Pancreatic Research Center), Largo A. Gemelli, 8, 00168, Roma, Italy; Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8, 00168, Roma, Italy
| | - Claudio Fiorillo
- Pancreatic Surgery Center, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy; CRMPG (Advanced Pancreatic Research Center), Largo A. Gemelli, 8, 00168, Roma, Italy.
| | - Davide De Sio
- Pancreatic Surgery Center, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy; CRMPG (Advanced Pancreatic Research Center), Largo A. Gemelli, 8, 00168, Roma, Italy
| | - Vito Laterza
- Pancreatic Surgery Center, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy; CRMPG (Advanced Pancreatic Research Center), Largo A. Gemelli, 8, 00168, Roma, Italy
| | - Roberta Menghi
- Pancreatic Surgery Center, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy; CRMPG (Advanced Pancreatic Research Center), Largo A. Gemelli, 8, 00168, Roma, Italy
| | - Caterina Cina
- Pancreatic Surgery Center, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy; CRMPG (Advanced Pancreatic Research Center), Largo A. Gemelli, 8, 00168, Roma, Italy
| | - Carlo Alberto Schena
- Pancreatic Surgery Center, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy; CRMPG (Advanced Pancreatic Research Center), Largo A. Gemelli, 8, 00168, Roma, Italy
| | - Fausto Rosa
- Pancreatic Surgery Center, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy; CRMPG (Advanced Pancreatic Research Center), Largo A. Gemelli, 8, 00168, Roma, Italy
| | - Federica Galiandro
- Pancreatic Surgery Center, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy; CRMPG (Advanced Pancreatic Research Center), Largo A. Gemelli, 8, 00168, Roma, Italy
| | - Sergio Alfieri
- Pancreatic Surgery Center, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy; CRMPG (Advanced Pancreatic Research Center), Largo A. Gemelli, 8, 00168, Roma, Italy; Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8, 00168, Roma, Italy
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