1207
THE OUTCOMES OF AMPULLARY ADENOMAS IN OBSERVATION WITHOUT INTERVENTION, ENDOSCOPIC PAPILLECTOMY, AND SURGICAL INTERVENTION
Date
May 21, 2024
Introduction:
Ampullary adenomas (AAs) can occur in a sporadic setting (SA) or genetic conditions, such as FAP and HNPCC. We aim to share the long-term follow-up data on observation without intervention, endoscopic intervention, and surgical intervention.
Methods:
This is a retrospective study of all patients with pathology-confirmed AAs from 1987 to 2023 at a tertiary cancer center.
Results:
Of 289 patients with AAs (207 FAP/HNPCC and 82 SA) with a mean follow-up of (MFU) 7.72 (+ 5.53) y, 187 were under observation (162 FAP/HNPCC, 25 SA) with MFU 4.50 (+ 6.00) y, 68 underwent endoscopic intervention [67 endoscopic papillectomy (EP) and 1 argon plasma coagulation (APC)] with MFU 5.40 (+ 7.01) y, and 34 surgery [30 pancreaticoduodenectomy (PD) with MFU 4.22 (+ 7.35) y and 4 surgical ampullectomy with MFU of 7.64 (+ 6.87) y. During the follow-up period, none of our 256 patients died from AAs. None of the 187 patients in the observation group developed cancer during the follow-up although 12% underwent endoscopic or surgical intervention due to progression of advanced adenomas.
For EP, the mean size of ampullary mass was 40.28 + 7.00 mm. The technical success rate of EP was 67/68 (98.5%) with en bloc resection rate 10/68 (14.7%). In en bloc resection, deep and lateral margins were negative in 80.0. Pancreatic duct stent was placed in all patients who underwent EP. The complications of EPs include mild pancreatitis in 4 (5.8%) and cholangitis 1 (1.5%). Surveillance endoscopy post EP was done at 3 months, at 1 year, and then yearly thereafter. The recurrence AAs after EPs were 13/68 (19.1%) in 352(21-4,001)d.
Secondary intervention of EP for development of HGD was performed in 3 (2 from EP and 1 from surgical ampullectomy), APC treatment in 7 (all from EP), and PD in 10 (8 from EP and 2 from surgical ampullectomy), and two excisions by biopsy (all from EP) in 695 d (102-3013)d.
Of the 4 surgical ampullectomies, 3 patients required secondary intervention with EP in 1 and PD in 2.
Complications of surgical intervention were noted in 12/34 (43.5%) patients, including 4 pancreatic leak, 1 bile leak, 3 abscesses/infections, 1 chylous leak, 1 atelectasis, 1 respiratory insufficiency, and 1 pancreatitis.
Discussion:
When observation was chosen for AAs in FAP/HNPCC, progression of adenoma that needed intervention occurred within 5 years without observing any developing adenocarcinoma. EP had a high technical success rate with a low adverse event, but with a high recurrence rate. Surgical intervention had a low recurrence rate but a high adverse event rate. These findings should be considered when managing AAs, especially in hereditary conditions.
Ampullary adenomas (AAs) can occur in a sporadic setting (SA) or genetic conditions, such as FAP and HNPCC. We aim to share the long-term follow-up data on observation without intervention, endoscopic intervention, and surgical intervention.
Methods:
This is a retrospective study of all patients with pathology-confirmed AAs from 1987 to 2023 at a tertiary cancer center.
Results:
Of 289 patients with AAs (207 FAP/HNPCC and 82 SA) with a mean follow-up of (MFU) 7.72 (+ 5.53) y, 187 were under observation (162 FAP/HNPCC, 25 SA) with MFU 4.50 (+ 6.00) y, 68 underwent endoscopic intervention [67 endoscopic papillectomy (EP) and 1 argon plasma coagulation (APC)] with MFU 5.40 (+ 7.01) y, and 34 surgery [30 pancreaticoduodenectomy (PD) with MFU 4.22 (+ 7.35) y and 4 surgical ampullectomy with MFU of 7.64 (+ 6.87) y. During the follow-up period, none of our 256 patients died from AAs. None of the 187 patients in the observation group developed cancer during the follow-up although 12% underwent endoscopic or surgical intervention due to progression of advanced adenomas.
For EP, the mean size of ampullary mass was 40.28 + 7.00 mm. The technical success rate of EP was 67/68 (98.5%) with en bloc resection rate 10/68 (14.7%). In en bloc resection, deep and lateral margins were negative in 80.0. Pancreatic duct stent was placed in all patients who underwent EP. The complications of EPs include mild pancreatitis in 4 (5.8%) and cholangitis 1 (1.5%). Surveillance endoscopy post EP was done at 3 months, at 1 year, and then yearly thereafter. The recurrence AAs after EPs were 13/68 (19.1%) in 352(21-4,001)d.
Secondary intervention of EP for development of HGD was performed in 3 (2 from EP and 1 from surgical ampullectomy), APC treatment in 7 (all from EP), and PD in 10 (8 from EP and 2 from surgical ampullectomy), and two excisions by biopsy (all from EP) in 695 d (102-3013)d.
Of the 4 surgical ampullectomies, 3 patients required secondary intervention with EP in 1 and PD in 2.
Complications of surgical intervention were noted in 12/34 (43.5%) patients, including 4 pancreatic leak, 1 bile leak, 3 abscesses/infections, 1 chylous leak, 1 atelectasis, 1 respiratory insufficiency, and 1 pancreatitis.
Discussion:
When observation was chosen for AAs in FAP/HNPCC, progression of adenoma that needed intervention occurred within 5 years without observing any developing adenocarcinoma. EP had a high technical success rate with a low adverse event, but with a high recurrence rate. Surgical intervention had a low recurrence rate but a high adverse event rate. These findings should be considered when managing AAs, especially in hereditary conditions.
Presenter
MD Anderson Cancer Center
Speakers
The University of Texas MD Anderson Cancer Center
The University of Texas MD Anderson Cancer Center
The University of Texas MD Anderson Cancer Center
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