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Vu Trung K, Heise C, Abou-Ali E, Auriemma F, Karam E, van der Wiel SE, Bruno MJ, Caillol F, Giovannini M, Masaryk V, Will U, Anderloni A, Pérez-Cuadrado-Robles E, Dugic A, Meier B, Paik WH, Petrone MC, Wichmann D, Dinis-Ribeiro M, Gonçalves TC, Wedi E, Schmidt A, Gulla A, Hoffmeister A, Rosendahl J, Ratone JP, Saadeh R, Repici A, Deprez P, Sauvanet A, Souche FR, Fabre JM, Muehldorfer S, Caca K, Löhr M, Michl P, Krug S, Regner S, Gaujoux S, Hollenbach M. Endoscopic papillectomy for ampullary lesions of minor papilla. Gastrointest Endosc 2024; 99:587-595.e1. [PMID: 37951279 DOI: 10.1016/j.gie.2023.10.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 09/26/2023] [Accepted: 10/17/2023] [Indexed: 11/13/2023]
Abstract
BACKGROUND AND AIMS Ampullary lesions (ALs) of the minor duodenal papilla are extremely rare. Endoscopic papillectomy (EP) is a routinely used treatment for AL of the major duodenal papilla, but the role of EP for minor AL has not been accurately studied. METHODS We identified 20 patients with ALs of minor duodenal papilla in the multicentric database from the Endoscopic Papillectomy vs Surgical Ampullectomy vs Pancreatitcoduodenectomy for Ampullary Neoplasm study, which included 1422 EPs. We used propensity score matching (nearest-neighbor method) to match these cases with ALs of the major duodenal papilla based on age, sex, histologic subtype, and size of the lesion in a 1:2 ratio. Cohorts were compared by means of chi-square or Fisher exact test as well as Mann-Whitney U test. RESULTS Propensity score-based matching identified a cohort of 60 (minor papilla 20, major papilla 40) patients with similar baseline characteristics. The most common histologic subtype of lesions of minor papilla was an ampullary adenoma in 12 patients (3 low-grade dysplasia and 9 high-grade dysplasia). Five patients revealed nonneoplastic lesions. Invasive cancer (T1a), adenomyoma, and neuroendocrine neoplasia were each found in 1 case. The rate of complete resection, en-bloc resection, and recurrences were similar between the groups. There were no severe adverse events after EP of lesions of minor papilla. One patient had delayed bleeding that could be treated by endoscopic hemostasis, and 2 patients showed a recurrence in surveillance endoscopy after a median follow-up of 21 months (interquartile range, 12-50 months). CONCLUSIONS EP is safe and effective in ALs of the minor duodenal papilla. Such lesions could be managed according to guidelines for EP of major duodenal papilla.
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Affiliation(s)
- Kien Vu Trung
- Division of Gastroenterology, Medical Department II, University of Leipzig Medical Center, Leipzig, Germany
| | - Christian Heise
- Medical Department I, Martin-Luther University Halle-Wittenberg, Halle, Germany
| | - Einas Abou-Ali
- Department of Gastroenterology, Digestive Oncology, and Endoscopy, Cochin Hospital, Paris Descartes University, Paris, France
| | - Francesco Auriemma
- Digestive Endoscopy Unit, Division of Gastroenterology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Elias Karam
- Department of Digestive Surgery, INSERM U1086 ANTICIPE, Centre Hospitalo-Universitaire de Caen, Caen, France
| | - Sophia E van der Wiel
- Department of Gastroenterology and Hepatology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Marco J Bruno
- Department of Gastroenterology and Hepatology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Fabrice Caillol
- Department of Endoscopy, Institut Paoli Calmettes, Marseille, France
| | - Marc Giovannini
- Department of Endoscopy, Institut Paoli Calmettes, Marseille, France
| | - Viliam Masaryk
- Department of Gastroenterology, Hepatology, Diabetes and General Internal Medicine, SRH Wald-Klinikum Gera, Gera, Germany
| | - Uwe Will
- Department of Gastroenterology, Hepatology, Diabetes and General Internal Medicine, SRH Wald-Klinikum Gera, Gera, Germany
| | - Andrea Anderloni
- Digestive Endoscopy Unit, Division of Gastroenterology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Enrique Pérez-Cuadrado-Robles
- Interventional Endoscopy, Department of Gastroenterology, Hôpital Européen Georges-Pompidou, Paris, France; Department of Gastroenterology, Cliniques Universitaires Saint-Luc, Bruxelles, Belgium
| | - Ana Dugic
- Department of Gastroenterology, Friedrich-Alexander-University Erlangen-Nuremberg, Medical Campus Oberfranken, Bayreuth, Germany
| | - Benjamin Meier
- Department of Medicine, Gastroenterology, Hematology, Oncology, Pneumology, Diabetes, and Infectious Diseases, RKH Clinic Ludwigsburg, Ludwigsburg, Germany
| | - Woo H Paik
- Division of Gastroenterology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Maria C Petrone
- Endosonography Unit, Pancreatobiliary Endoscopy and Endosonography Division, San Raffaele Scientific Institute, Vita Salute San Raffaele University, Milan, Italy
| | - Dörte Wichmann
- Department of General, Visceral, and Transplantation Surgery, University Hospital of Tübingen, Tübingen, Germany
| | - Mario Dinis-Ribeiro
- Department of Gastroenterology, Instituto Português de Oncologia do Porto, Porto, Portugal; RISE@CI-IPO (Health Research Network), Portuguese Oncology Institute of Porto/Porto Comprehensive Cancer Center, Porto, Portugal; Department of Community Medicine, Health Information, and Decision, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Tiago C Gonçalves
- Gastroenterology Department, Hospital da Senhora da Oliveira, Guimarães, Portugal; School of Medicine, University of Minho, Braga/Guimarães, Portugal; PT Government Associate Laboratory, ICVS/3B, Braga/Guimarães, Portugal
| | - Edris Wedi
- Department of Gastroenterology and Gastrointestinal Oncology, University Medicine Göttingen, Göttingen, Germany; Department of Gastroenterology, Gastrointestinal Oncology and Interventional Endoscopy, Sana Clinic Offenbach, Offenbach, Germany
| | - Arthur Schmidt
- Department of Medicine II, University of Freiburg Medical Center, Freiburg, Germany
| | - Aiste Gulla
- Department of Surgery, Lithuanian University of Health Sciences, Santaros Klinikos, Kaunas, Lithuania; General Surgery, MedStar Georgetown University Hospital, John Hopkins University, Washington, DC, USA
| | - Albrecht Hoffmeister
- Division of Gastroenterology, Medical Department II, University of Leipzig Medical Center, Leipzig, Germany
| | - Jonas Rosendahl
- Medical Department I, Martin-Luther University Halle-Wittenberg, Halle, Germany
| | | | - Rita Saadeh
- Department of Gastroenterology, Hepatology, Diabetes and General Internal Medicine, SRH Wald-Klinikum Gera, Gera, Germany
| | - Alessandro Repici
- Digestive Endoscopy Unit, Division of Gastroenterology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Pierre Deprez
- Department of Medicine, Gastroenterology, Hematology, Oncology, Pneumology, Diabetes, and Infectious Diseases, RKH Clinic Ludwigsburg, Ludwigsburg, Germany
| | - Alain Sauvanet
- Department of Digestive Surgery, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris, Clichy, France
| | - Francois R Souche
- Department of Digestive Surgery, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - Jean M Fabre
- Department of Digestive Surgery, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - Steffen Muehldorfer
- Department of Gastroenterology, Friedrich-Alexander-University Erlangen-Nuremberg, Medical Campus Oberfranken, Bayreuth, Germany
| | - Karel Caca
- Department of Medicine, Gastroenterology, Hematology, Oncology, Pneumology, Diabetes, and Infectious Diseases, RKH Clinic Ludwigsburg, Ludwigsburg, Germany
| | - Matthias Löhr
- Division of Surgery, Department of Clinical Science, Intervention, and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Patrick Michl
- Department of Internal Medicine IV, University Hospital Heidelberg, Heidelberg, Germany
| | - Sebastian Krug
- Department of Internal Medicine IV, University Hospital Heidelberg, Heidelberg, Germany
| | - Sara Regner
- Section for Surgery, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
| | - Sebastien Gaujoux
- Department of Pancreatic and Endocrine Surgery, Pitié-Salpetriere Hospital, Médecine Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Marcus Hollenbach
- Division of Gastroenterology, Medical Department II, University of Leipzig Medical Center, Leipzig, Germany; Department of Internal Medicine IV, University Hospital Heidelberg, Heidelberg, Germany
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Vu Trung K, Abou-Ali E, Caillol F, Paik WH, Napoleon B, Masaryk V, van der Wiel SE, Pérez-Cuadrado-Robles E, Musquer N, Halimi A, Soares K, Souche FR, Seyfried S, Petrone MC, Crippa S, Kleemann T, Albers D, Weismüller TJ, Dugic A, Meier B, Wedi E, Schiemer M, Regner S, Gaujoux S, Hollenbach M. Endoscopic papillectomy for ampullary lesions in patients with familial adenomatous polyposis compared with sporadic lesions: a propensity score-matched cohort. Endoscopy 2023; 55:709-718. [PMID: 36746390 DOI: 10.1055/a-2029-2935] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Familial adenomatous polyposis (FAP) is a rare inherited syndrome that predisposes the patient to cancer. Treatment of FAP-related ampullary lesions is challenging and the role of endoscopic papillectomy has not been elucidated. We retrospectively analyzed the outcomes of endoscopic papillectomy in matched cohorts of FAP-related and sporadic ampullary lesions (SALs). METHODS This retrospective multicenter study included 1422 endoscopic papillectomy procedures. Propensity score matching including age, sex, comorbidity, histologic subtype, and size was performed. Main outcomes were complete resection (R0), technical success, complications, and recurrence. RESULTS Propensity score matching identified 202 patients (101 FAP, 101 SAL) with comparable baseline characteristics. FAP patients were mainly asymptomatic (79.2 % [95 %CI 71.2-87.3] vs. 46.5 % [95 %CI 36.6-56.4]); P < 0.001). The initial R0 rate was significantly lower in FAP patients (63.4 % [95 %CI 53.8-72.9] vs. 83.2 % [95 %CI 75.8-90.6]; P = 0.001). After repeated interventions (mean 1.30 per patient), R0 was comparable (FAP 93.1 % [95 %CI 88.0-98.1] vs. SAL 97.0 % [95 %CI 93.7-100]; P = 0.19). Adverse events occurred in 28.7 %. Pancreatitis and bleeding were the most common adverse events in both groups. Severe adverse events were rare (3.5 %). Overall, 21 FAP patients (20.8 % [95 %CI 12.7-28.8]) and 16 SAL patients (15.8 % [95 %CI 8.6-23.1]; P = 0.36) had recurrence. Recurrences occurred later in FAP patients (25 [95 %CI 18.3-31.7] vs. 2 [95 %CI CI 0.06-3.9] months). CONCLUSIONS Endoscopic papillectomy was safe and effective in FAP-related ampullary lesions. Criteria for endoscopic resection of ampullary lesions can be extended to FAP patients. FAP patients have a lifetime risk of relapse even after complete resection, and require long-time surveillance.
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Affiliation(s)
- Kien Vu Trung
- Division of Gastroenterology, Medical Department II, University of Leipzig Medical Center, Leipzig, Germany
| | - Einas Abou-Ali
- Department of Gastroenterology, Digestive Oncology and Endoscopy, Cochin Hospital, Paris Descartes University, Paris, France
| | - Fabrice Caillol
- Department of Endoscopy, Institut Paoli Calmettes, Marseille, France
| | - Woo H Paik
- Division of Gastroenterology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | | | - Viliam Masaryk
- Department of Gastroenterology, Hepatology, Diabetes and General Internal Medicine, SRH Wald-Klinikum Gera, Gera, Germany
| | - Sophia E van der Wiel
- Department of Gastroenterology and Hepatology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Enrique Pérez-Cuadrado-Robles
- Interventional Endoscopy, Hôpital Européen Georges-Pompidou, Department of Gastroenterology, Georges-Pompidou European Hospital, Paris, France
- Department of Gastroenterology, Cliniques universitaires Saint-Luc, Bruxelles, Belgium
| | | | - Asif Halimi
- Division of Surgery, CLINTEC, Karolinska Institutet, Stockholm, Sweden
- Department of Surgical and Perioperative Sciences, Surgery, University of Umeå, Umeå, Sweden
| | - Kevin Soares
- Hepatopancreatobiliary Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, United States
| | - Francois R Souche
- Department of Digestive Surgery, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - Steffen Seyfried
- Interdisciplinary Endoscopy Unit, Mannheim Medical Center, Ruprecht-Karls-University Heidelberg, Mannheim, Germany
- Department of Surgery, Mannheim Medical Center, Ruprecht-Karls-University Heidelberg, Mannheim, Germany
| | - Maria C Petrone
- Endosonography Unit, Pancreato-Biliary Endoscopy and Endosonography Division, San Raffaele Scientific Institute, Vita Salute San Raffaele University, Milan, Italy
| | - Stefano Crippa
- Department of Pancreatic Surgery, Vita Salute San Raffaele University, Milan, Italy
| | - Tobias Kleemann
- Department of Gastroenterology and Rheumatology, Carl-Thiem-Klinikum Cottbus, Cottbus, Germany
| | - David Albers
- Department of Medicine and Gastroenterology, Contilia Clinic Essen, Essen, Germany
| | - Tobias J Weismüller
- Department of Internal Medicine - Gastroenterology and Oncology, Vivantes Humboldt Hospital, Berlin, Germany
- Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany
| | - Ana Dugic
- Division of Surgery, CLINTEC, Karolinska Institutet, Stockholm, Sweden
- Department of Gastroenterology, Friedrich-Alexander-University Erlangen-Nuremberg, Medical Campus Oberfranken, Bayreuth, Germany
| | - Benjamin Meier
- Department of Medicine, Gastroenterology, Hematology, Oncology, Pneumology, Diabetes and Infectious Diseases; RKH Clinic Ludwigsburg, Ludwigsburg, Germany
| | - Edris Wedi
- Department of Gastroenterology and Gastrointestinal Oncology, University Medicine Göttingen, Göttingen, Germany
- Department of Gastroenterology, Gastrointestinal Oncology and Interventional Endoscopy, Sana Clinic Offenbach, Offenbach, Germany
| | - Moritz Schiemer
- Department of Medicine II, University of Freiburg Medical Center, Freiburg, Germany
| | - Sara Regner
- Department of Clinical Sciences Malmö, Section for Surgery, Lund University, Lund, Sweden
| | - Sebastien Gaujoux
- Department of Digestive and HBP Surgery, Groupe Hospitalier Pitié-Salpêtrière APHP, Médecine Sorbonne Université, Paris, France
| | - Marcus Hollenbach
- Division of Gastroenterology, Medical Department II, University of Leipzig Medical Center, Leipzig, Germany
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3
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Karam E, Hollenbach M, Ali EA, Auriemma F, Gulla A, Heise C, Regner S, Gaujoux S, Regimbeau JM, Kähler G, Seyfried S, Vaillant JC, De Ponthaud C, Sauvanet A, Birnbaum D, Regenet N, Truant S, Pérez-Cuadrado-Robles E, Bruzzi M, Lupinacci RM, Brunel M, Belfiori G, Barbier L, Salamé E, Souche FR, Schwarz L, Maggino L, Salvia R, Gagniére J, Del Chiaro M, Leung G, Hackert T, Kleemann T, Paik WH, Caca K, Dugic A, Muehldorfer S, Schumacher B, Albers D. Outcomes of rescue procedures in the management of locally recurrent ampullary tumors: A Pancreas 2000/EPC study. Surgery 2023; 173:1254-1262. [PMID: 36642655 DOI: 10.1016/j.surg.2022.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 11/15/2022] [Accepted: 12/13/2022] [Indexed: 01/15/2023]
Abstract
BACKGROUND Ampullary lesions are rare and can be locally treated either with endoscopic papillectomy or transduodenal surgical ampullectomy. Management of local recurrence after a first-line treatment has been poorly studied. METHODS Patients with a local recurrence of an ampullary lesion initially treated with endoscopic papillectomy or transduodenal surgical ampullectomy were retrospectively included from a multi-institutional database (58 centers) between 2005 and 2018. RESULTS A total of 103 patients were included, 21 (20.4%) treated with redo endoscopic papillectomy, 14 (13.6%) with transduodenal surgical ampullectomy, and 68 (66%) with pancreaticoduodenectomy. Redo endoscopic papillectomy had low morbidity with 4.8% (n = 1) severe to fatal complications and a R0 rate of 81% (n = 17). Transduodenal surgical ampullectomy and pancreaticoduodenectomy after a first procedure had a higher morbidity with Clavien III and more complications, respectively, 28.6% (n = 4) and 25% (n = 17); R0 resection rates were 85.7% (n = 12) and 92.6% (n = 63), both without statistically significant difference compared to endoscopic papillectomy (P = .1 and 0.2). Pancreaticoduodenectomy had 4.4% (n = 2) mortality. No deaths were registered after transduodenal surgical ampullectomy or endoscopic papillectomy. Recurrences treated with pancreaticoduodenectomy were more likely to be adenocarcinomas (79.4%, n = 54 vs 21.4%, n = 3 for transduodenal surgical ampullectomy and 4.8%, n = 1 for endoscopic papillectomy, P < .0001). Three-year overall survival and disease-free survival were comparable. CONCLUSION Endoscopy is appropriate for noninvasive recurrences, with resection rate and survival outcomes comparable to surgery. Surgery applies more to invasive recurrences, with transduodenal surgical ampullectomy rather for carcinoma in situ and early cancers and pancreaticoduodenectomy for more advanced tumors.
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Affiliation(s)
- Elias Karam
- Department of Visceral Surgery, Hepato-Biliary, Pancreatic and Liver Transplantation Unit, Tours University Hospital, France.
| | - Marcus Hollenbach
- University of Leipzig Medical Center, Medical Department II-Gastroenterology, Hepatology, Infectious Diseases, Pulmonology, Leipzig, Germany
| | - Einas Abou Ali
- Department of Gastroenterology, Digestive Oncology, and Endoscopy, Cochin Hospital, Paris, France
| | - Francesco Auriemma
- Humanitas Clinical and Research Hospital, Rozzano, Digestive Endoscopy Unit, Division of Gastroenterology, Milan, Italy
| | - Aiste Gulla
- Department of Surgery, Lithuanian University of Health Sciences, Kaunas, Lithuania; Johns Hopkins University, MedStar Georgetown University Hospital, General Surgery, Washington, DC
| | - Christian Heise
- Martin-Luther University Halle-Wittenberg Department of Medicine I-Gastroenterology, Pulmonology, Halle, Germany
| | - Sara Regner
- Department of Clinical Sciences Malmö, Lund University, Sweden
| | - Sébastien Gaujoux
- Department of Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, AP-HP Pitié-Salpêtrière Hospital, Paris, France; Sorbonne University, Paris, France
| | | | - Jean M Regimbeau
- Department of Digestive Surgery, Center Hospitalo-Universitaire Amiens-Picardie, Amiens, France
| | - Georg Kähler
- Interdisciplinary Endoscopy Unit, Mannheim Medical Center, Ruprecht-Karls-University Heidelberg, Mannheim, Germany; Department of Surgery, Mannheim Medical Center, Ruprecht-Karls-University Heidelberg, Mannheim, Germany
| | - Steffen Seyfried
- Interdisciplinary Endoscopy Unit, Mannheim Medical Center, Ruprecht-Karls-University Heidelberg, Mannheim, Germany; Department of Surgery, Mannheim Medical Center, Ruprecht-Karls-University Heidelberg, Mannheim, Germany
| | - Jean C Vaillant
- Department of Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, AP-HP Pitié-Salpêtrière Hospital, Paris, France
| | - Charles De Ponthaud
- Department of Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, AP-HP Pitié-Salpêtrière Hospital, Paris, France
| | - Alain Sauvanet
- Department of Digestive Surgery, Beaujon Hospital, APHP, Clichy, France
| | - David Birnbaum
- Department of Digestive Surgery, Hôpital Nord, Assistance Publique - Hôpitaux de Marseille, Aix-Marseille University, Marseille, France
| | - Nicolas Regenet
- Department of Digestive Surgery, Centre Hospitalier Universitaire de Nantes, France
| | - Stéphanie Truant
- Deparment of Digestive Surgery, Centre Hospitalo-Universitaire de Lille, France
| | | | - Matthieu Bruzzi
- Department of Digestive Surgery, Hôpital Européen Georges Pompidou, APHP, Paris, France
| | - Renato M Lupinacci
- Department of Digestive Surgery, Groupe Hospitalier Diaconesses Croix Saint-Simon, Paris, France
| | - Martin Brunel
- Department of Digestive Surgery, Hôpital André Mignot, Versailles, France
| | - Giulio Belfiori
- Department of Pancreatic Surgery, Vita Salute San Raffaele University, Milan, Italy
| | - Louise Barbier
- Department of Visceral Surgery, Hepato-Biliary, Pancreatic and Liver Transplantation Unit, Tours University Hospital, France
| | - Ephrem Salamé
- Department of Visceral Surgery, Hepato-Biliary, Pancreatic and Liver Transplantation Unit, Tours University Hospital, France
| | - Francois R Souche
- Department of Digestive Surgery, Centre Hospitalier Universitaire de Montpellier, France
| | - Lilian Schwarz
- Department of Digestive Surgery, Hôpital Charles-Nicolle, Centre Hospitalier Universitaire de Rouen, France
| | - Laura Maggino
- Unit of General and Pancreatic Surgery, The Pancreas Institute Verona, Department of Surgery, Dentistry, Paediatrics, and Gynaecology, University of Verona, Italy
| | - Roberto Salvia
- Unit of General and Pancreatic Surgery, The Pancreas Institute Verona, Department of Surgery, Dentistry, Paediatrics, and Gynaecology, University of Verona, Italy
| | - Johan Gagniére
- Department of Digestive and Hepatobiliary Surgery, Estaing University Hospital, Clermont-Ferrand, France; U1071 Inserm / Clermont-Auvergne University, Clermont-Ferrand, France
| | - Marco Del Chiaro
- Department of Surgery, University of Colorado Anschutz Medical Campus, CO
| | - Galen Leung
- Division of Gastroenterology and Hepatology, University of Pennsylvania Perelman School of Medicine, PA
| | - Thilo Hackert
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Germany
| | - Tobias Kleemann
- Department of Gastroenterology and Rheumatology, Carl-Thiem-Klinikum Cottbus, Germany
| | - Woo H Paik
- Division of Gastroenterology, Department of Internal Medicine, Seoul National University Hospital, Republic of Korea
| | - Karel Caca
- Department of Medicine, Gastroenterology, Hematology, Oncology, Pneumology, Diabetes and Infectious Diseases, RKH Clinic Ludwigsburg, Germany
| | - Ana Dugic
- Department of Gastroenterology, Friedrich-Alexander-University Erlangen-Nuremberg, Medical Campus Oberfranken, Bayreuth, Germany
| | - Steffen Muehldorfer
- Department of Gastroenterology, Friedrich-Alexander-University Erlangen-Nuremberg, Medical Campus Oberfranken, Bayreuth, Germany
| | | | - David Albers
- Department of Medicine and Gastroenterology, Contilia Clinic Essen, Germany
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4
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Hobeika C, Fuks D, Cauchy F, Goumard C, Soubrane O, Gayet B, Salamé E, Cherqui D, Vibert E, Scatton O, Nomi T, Oudafal N, Kawai T, Komatsu S, Okumura S, Petrucciani N, Laurent A, Bucur P, Barbier L, Trechot B, Nunèz J, Tedeschi M, Allard MA, Golse N, Ciacio O, Pittau G, Cunha AS, Adam R, Laurent C, Chiche L, Leourier P, Rebibo L, Regimbeau JM, Ferre L, Souche FR, Chauvat J, Fabre JM, Jehaes F, Mohkam K, Lesurtel M, Ducerf C, Mabrut JY, Hor T, Paye F, Balladur P, Suc B, Muscari F, Millet G, El Amrani M, Ratajczak C, Lecolle K, Boleslawski E, Truant S, Pruvot FR, Kianmanesh AR, Codjia T, Schwarz L, Girard E, Abba J, Letoublon C, Chirica M, Carmelo A, VanBrugghe C, Cherkaoui Z, Unterteiner X, Memeo R, Pessaux P, Buc E, Lermite E, Barbieux J, Bougard M, Marchese U, Ewald J, Turini O, Thobie A, Menahem B, Mulliri A, Lubrano J, Zemour J, Fagot H, Passot G, Gregoire E, Hardwigsen J, le Treut YP, Patrice D. Impact of cirrhosis in patients undergoing laparoscopic liver resection in a nationwide multicentre survey. Br J Surg 2020; 107:268-277. [PMID: 31916594 DOI: 10.1002/bjs.11406] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 09/21/2019] [Accepted: 09/27/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND The aim was to analyse the impact of cirrhosis on short-term outcomes after laparoscopic liver resection (LLR) in a multicentre national cohort study. METHODS This retrospective study included all patients undergoing LLR in 27 centres between 2000 and 2017. Cirrhosis was defined as F4 fibrosis on pathological examination. Short-term outcomes of patients with and without liver cirrhosis were compared after propensity score matching by centre volume, demographic and tumour characteristics, and extent of resection. RESULTS Among 3150 patients included, LLR was performed in 774 patients with (24·6 per cent) and 2376 (75·4 per cent) without cirrhosis. Severe complication and mortality rates in patients with cirrhosis were 10·6 and 2·6 per cent respectively. Posthepatectomy liver failure (PHLF) developed in 3·6 per cent of patients with cirrhosis and was the major cause of death (11 of 20 patients). After matching, patients with cirrhosis tended to have higher rates of severe complications (odds ratio (OR) 1·74, 95 per cent c.i. 0·92 to 3·41; P = 0·096) and PHLF (OR 7·13, 0·91 to 323·10; P = 0·068) than those without cirrhosis. They also had a higher risk of death (OR 5·13, 1·08 to 48·61; P = 0·039). Rates of cardiorespiratory complications (P = 0·338), bile leakage (P = 0·286) and reoperation (P = 0·352) were similar in the two groups. Patients with cirrhosis had a longer hospital stay than those without (11 versus 8 days; P = 0·018). Centre expertise was an independent protective factor against PHLF in patients with cirrhosis (OR 0·33, 0·14 to 0·76; P = 0·010). CONCLUSION Underlying cirrhosis remains an independent risk factor for impaired outcomes in patients undergoing LLR, even in expert centres.
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Affiliation(s)
- C Hobeika
- Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Sorbonne Université, Centre de Recherche Scientifique Saint Antoine, Hôpital Pitié Salpétrière, Paris, France
| | - D Fuks
- Department of Digestive, Oncological and Metabolic Surgery, Institut Mutualiste Montsouris, University Paris Descartes, Paris, France
| | - F Cauchy
- Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Hôpital Beaujon, Clichy, France
| | - C Goumard
- Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Sorbonne Université, Centre de Recherche Scientifique Saint Antoine, Hôpital Pitié Salpétrière, Paris, France
| | - O Soubrane
- Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Hôpital Beaujon, Clichy, France
| | - B Gayet
- Department of Digestive, Oncological and Metabolic Surgery, Institut Mutualiste Montsouris, University Paris Descartes, Paris, France
| | - E Salamé
- Department of Digestive Surgery and Liver Transplantation, Trousseau University Hospital, Tours University, Tours, France
| | - D Cherqui
- Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Centre Hépato-biliaire de Paul Brousse, Villejuif, France
| | - E Vibert
- Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Centre Hépato-biliaire de Paul Brousse, Villejuif, France
| | - O Scatton
- Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Sorbonne Université, Centre de Recherche Scientifique Saint Antoine, Hôpital Pitié Salpétrière, Paris, France
| | | | - T Nomi
- Nara Medical University, Nara, Japan
| | - N Oudafal
- Institut Mutualiste Montsouris, Paris, France
| | - T Kawai
- Pitié Salpétrière Hospital, Assistance Publique - Hôpitaux de Paris (APHP), Paris, France
| | - S Komatsu
- Pitié Salpétrière Hospital, Assistance Publique - Hôpitaux de Paris (APHP), Paris, France
| | - S Okumura
- Pitié Salpétrière Hospital, Assistance Publique - Hôpitaux de Paris (APHP), Paris, France
| | | | - A Laurent
- Hôpital Henri Mondor, APHP, Creteil, France
| | - P Bucur
- Trousseau Hospital, University Hospital Centre of Tours, Tours, France
| | - L Barbier
- Trousseau Hospital, University Hospital Centre of Tours, Tours, France
| | - B Trechot
- Centre Hépato-biliaire de Paul Brousse, APHP, Villejuif, France
| | - J Nunèz
- Centre Hépato-biliaire de Paul Brousse, APHP, Villejuif, France
| | - M Tedeschi
- Centre Hépato-biliaire de Paul Brousse, APHP, Villejuif, France
| | - M-A Allard
- Centre Hépato-biliaire de Paul Brousse, APHP, Villejuif, France
| | - N Golse
- Centre Hépato-biliaire de Paul Brousse, APHP, Villejuif, France
| | - O Ciacio
- Centre Hépato-biliaire de Paul Brousse, APHP, Villejuif, France
| | - G Pittau
- Centre Hépato-biliaire de Paul Brousse, APHP, Villejuif, France
| | - A Sa Cunha
- Centre Hépato-biliaire de Paul Brousse, APHP, Villejuif, France
| | - R Adam
- Centre Hépato-biliaire de Paul Brousse, APHP, Villejuif, France
| | - C Laurent
- Hospital University Centre of Bordeaux, Bordeaux, France
| | - L Chiche
- Hospital University Centre of Bordeaux, Bordeaux, France
| | - P Leourier
- Hospital University Centre of Amiens-Picardie, Amiens, France
| | - L Rebibo
- Hospital University Centre of Amiens-Picardie, Amiens, France
| | - J-M Regimbeau
- Hospital University Centre of Amiens-Picardie, Amiens, France
| | - L Ferre
- Saint Eloi Hospital, Hospital University Centre of Montpellier, Montpellier, France
| | - F R Souche
- Saint Eloi Hospital, Hospital University Centre of Montpellier, Montpellier, France
| | - J Chauvat
- Saint Eloi Hospital, Hospital University Centre of Montpellier, Montpellier, France
| | - J-M Fabre
- Saint Eloi Hospital, Hospital University Centre of Montpellier, Montpellier, France
| | - F Jehaes
- Croix Rousse Hospital, Hospices Civils de Lyon, Lyon, France
| | - K Mohkam
- Croix Rousse Hospital, Hospices Civils de Lyon, Lyon, France
| | - M Lesurtel
- Croix Rousse Hospital, Hospices Civils de Lyon, Lyon, France
| | - C Ducerf
- Croix Rousse Hospital, Hospices Civils de Lyon, Lyon, France
| | - J-Y Mabrut
- Croix Rousse Hospital, Hospices Civils de Lyon, Lyon, France
| | - T Hor
- St Antoine Hospital, APHP, Paris, France
| | - F Paye
- St Antoine Hospital, APHP, Paris, France
| | - P Balladur
- St Antoine Hospital, APHP, Paris, France
| | - B Suc
- Rangueil Hospital, Hospital University Centre of Toulouse, Toulouse, France
| | - F Muscari
- Rangueil Hospital, Hospital University Centre of Toulouse, Toulouse, France
| | - G Millet
- Claude Huriez Hospital, Hospital University Centre of Lille, Lille, France
| | - M El Amrani
- Claude Huriez Hospital, Hospital University Centre of Lille, Lille, France
| | - C Ratajczak
- Claude Huriez Hospital, Hospital University Centre of Lille, Lille, France
| | - K Lecolle
- Claude Huriez Hospital, Hospital University Centre of Lille, Lille, France
| | - E Boleslawski
- Claude Huriez Hospital, Hospital University Centre of Lille, Lille, France
| | - S Truant
- Claude Huriez Hospital, Hospital University Centre of Lille, Lille, France
| | - F-R Pruvot
- Claude Huriez Hospital, Hospital University Centre of Lille, Lille, France
| | - A-R Kianmanesh
- Robert Debré Hospital, Hospital University Centre of Reims, Reims, France
| | - T Codjia
- Charles Nicolle Hospital, Hospital University Centre of Rouen, Rouen, France
| | - L Schwarz
- Charles Nicolle Hospital, Hospital University Centre of Rouen, Rouen, France
| | - E Girard
- Michalon Hospital, Hospital University Centre of Grenoble, Grebnoble, France
| | - J Abba
- Michalon Hospital, Hospital University Centre of Grenoble, Grebnoble, France
| | - C Letoublon
- Michalon Hospital, Hospital University Centre of Grenoble, Grebnoble, France
| | - M Chirica
- Michalon Hospital, Hospital University Centre of Grenoble, Grebnoble, France
| | | | | | - Z Cherkaoui
- Nouvel Hôpital Civil, Hospital University Centre of Strasbourg, Strasbourg, France
| | - X Unterteiner
- Nouvel Hôpital Civil, Hospital University Centre of Strasbourg, Strasbourg, France
| | - R Memeo
- Nouvel Hôpital Civil, Hospital University Centre of Strasbourg, Strasbourg, France
| | - P Pessaux
- Nouvel Hôpital Civil, Hospital University Centre of Strasbourg, Strasbourg, France
| | - E Buc
- Hospital University Centre of Clermont-Ferrand, Clermont-Ferrand, France
| | - E Lermite
- Hospital University Centre of Angers, Angers, France
| | - J Barbieux
- Hospital University Centre of Angers, Angers, France
| | - M Bougard
- Hospital University Centre of Angers, Angers, France
| | - U Marchese
- Institut Paoli-Calmettes, Marseille, France
| | - J Ewald
- Institut Paoli-Calmettes, Marseille, France
| | - O Turini
- Institut Paoli-Calmettes, Marseille, France
| | - A Thobie
- Hospital University Centre of Caen Normandie, Caen, France
| | - B Menahem
- Hospital University Centre of Caen Normandie, Caen, France
| | - A Mulliri
- Hospital University Centre of Caen Normandie, Caen, France
| | - J Lubrano
- Hospital University Centre of Caen Normandie, Caen, France
| | - J Zemour
- Hospital University Centre of Saint-Pierre, Saint Pierre, Department of Réunion, France
| | - H Fagot
- Hospital University Centre of Saint-Pierre, Saint Pierre, Department of Réunion, France
| | - G Passot
- Hospital University Centre of Lyon Sud, Lyon, France
| | - E Gregoire
- La Timone Hospital, Hospital University Centre of Marseille, Marseille, France
| | - J Hardwigsen
- La Timone Hospital, Hospital University Centre of Marseille, Marseille, France
| | - Y-P le Treut
- La Timone Hospital, Hospital University Centre of Marseille, Marseille, France
| | - D Patrice
- Louis Pasteur Hospital, Colmar, France
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