Hong SS, Han SS, Kwon W, Jang JY, Kim HJ, Cho CK, Ahn KS, Yang JD, Park Y, Min SK, Moon JI, Roh YH, Lee SE, Park JS, Kim SG, Jeong CY, Heo JS, Hwang HK. Comparison of Oncologic Outcomes between
Transduodenal Ampullectomy and Pancreatoduodenectomy in Ampulla of Vater Cancer: Korean Multicenter Study.
Cancers (Basel) 2021;
13:2038. [PMID:
33922504 DOI:
10.3390/cancers13092038]
[Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 04/19/2021] [Indexed: 12/15/2022] Open
Abstract
Simple Summary
This study used multicenter data to compare the oncological safety of transduodenal ampullectomy (TDA) with that of pylorus-preserving pancreatoduodenectomy (PPPD) in early ampulla of Vater (AoV) cancer. Data for patients who underwent surgical resection for AoV cancer (pTis–T2 stage) from 2000 to 2019 were collected from 15 institutions. A total of 486 patients were enrolled (PPPD, 418; TDA, 68). The oncologic behavior (tumor size, T stage, differentiation, lymphovascular invasion) in the PPPD group was more aggressive than that in the TDA group at all T stages. The 5-year disease-free survival and overall survival did not differ between the two groups when considering all T stages or only the Tis + T1 group. In T1 patients, PPPD had survival outcomes superior to those in the TDA group. In the TDA group, lymph node dissection did not affect survival. In conclusion, PPPD should be the standard procedure for early AoV cancer.
Abstract
This study used multicenter data to compare the oncological safety of transduodenal ampullectomy (TDA) with that of pylorus-preserving pancreatoduodenectomy (PPPD) in early ampulla of Vater (AoV) cancer. Data for patients who underwent surgical resection for AoV cancer (pTis–T2 stage) from January 2000 to September 2019 were collected from 15 institutions. The clinicopathologic characteristics and survival outcomes were compared between the PPPD and TDA groups. A total of 486 patients were enrolled (PPPD, 418; TDA, 68). The oncologic behavior in the PPPD group was more aggressive than that in the TDA group at all T stages: larger tumor size (p = 0.034), advanced T stage (p < 0.001), aggressive cell differentiation (p < 0.001), and more lymphovascular invasion (p = 0.002). Five-year disease-free survival (DFS) and overall survival (OS) did not differ between the two groups when considering all T stages or only the Tis+T1 group. Among T1 patients, PPPD produced significantly better DFS (PPPD vs. TDA, 84.8% vs. 66.6%, p = 0.040) and superior OS (PPPD vs. TDA, 89.1% vs. 68.0%, p = 0.056) than TDA. Lymph node dissection (LND) in the TDA group did not affect DFS or OS (TDA + LND vs. TDA-only, DFS, p = 0.784; OS, p = 0.870). In conclusion, PPPD should be the standard procedure for early AoV cancer.
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