Proposed indications for limited resection of early ampulla of Vater carcinoma: Clinico-histopathological criteria to confirm cure

Koichi Aiura, Taizo Hibi, Hiroto Fujisaki, Minoru Kitago, Minoru Tanabe, Shigeyuki Kawachi, Osamu Itano, Masahiro Shinoda, Hiroshi Yagi, Yohei Masugi, Michiie Sakamoto, Yuukou Kitagawa

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Background Limited resection is reserved for patients with high operative risk or benign adenomas. We aimed to define indications for limited resection of early ampulla of Vater carcinoma with curative intent through detailed preoperative examinations and histopathological evaluations. Methods We performed a retrospective cohort study of all consecutive Japanese patients who underwent resection for ampulla of Vater neoplasms at our hospital from 1986 to 2010. Results A total of 75 patients were identified. Moderately/ poorly differentiated histology, lympho-vascular/ perineural invasion, and duodenal/pancreatic invasion were significant risk factors for lymph node metastases. Macroscopically, non-exposed protruded- or ulcerative-type disease did not correlate directly with lymph node metastases; however, these tumor types were associated with other invasive features. In a subset of early carcinomas fulfilling the conditions of exposed protruded adenoma or papillary/well-differentiated adenocarcinoma determined by endoscopic biopsy, negative duodenal invasion determined by endoscopic ultrasonography, no tumor infiltration into the pancreatic duct determined by intraductal ultrasound, and diameter of the pancreatic duct ≤3 mm determined by endoscopic retrograde cholangiopancreatography (N = 11), the incidence of lymph node metastasis and tumor infiltration into the pancreatic duct was 0%. Conclusion Strictly selected patients with early ampulla of Vater carcinomas may benefit from limited resection if the resected specimen is evaluated to confirm all histopathological criteria.

Original languageEnglish
Pages (from-to)707-716
Number of pages10
JournalJournal of Hepato-Biliary-Pancreatic Sciences
Volume19
Issue number6
DOIs
Publication statusPublished - 2012 Nov

Fingerprint

Ampulla of Vater
Pancreatic Ducts
Carcinoma
Lymph Nodes
Neoplasm Metastasis
Adenoma
Neoplasms
Endosonography
Endoscopic Retrograde Cholangiopancreatography
Blood Vessels
Histology
Adenocarcinoma
Cohort Studies
Retrospective Studies
Biopsy
Incidence

Keywords

  • Ampulla of Vater carcinoma
  • Criteria
  • Indication
  • Limited resection
  • Local resection

ASJC Scopus subject areas

  • Hepatology
  • Surgery

Cite this

Proposed indications for limited resection of early ampulla of Vater carcinoma : Clinico-histopathological criteria to confirm cure. / Aiura, Koichi; Hibi, Taizo; Fujisaki, Hiroto; Kitago, Minoru; Tanabe, Minoru; Kawachi, Shigeyuki; Itano, Osamu; Shinoda, Masahiro; Yagi, Hiroshi; Masugi, Yohei; Sakamoto, Michiie; Kitagawa, Yuukou.

In: Journal of Hepato-Biliary-Pancreatic Sciences, Vol. 19, No. 6, 11.2012, p. 707-716.

Research output: Contribution to journalArticle

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AU - Kitago, Minoru

AU - Tanabe, Minoru

AU - Kawachi, Shigeyuki

AU - Itano, Osamu

AU - Shinoda, Masahiro

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AU - Masugi, Yohei

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AB - Background Limited resection is reserved for patients with high operative risk or benign adenomas. We aimed to define indications for limited resection of early ampulla of Vater carcinoma with curative intent through detailed preoperative examinations and histopathological evaluations. Methods We performed a retrospective cohort study of all consecutive Japanese patients who underwent resection for ampulla of Vater neoplasms at our hospital from 1986 to 2010. Results A total of 75 patients were identified. Moderately/ poorly differentiated histology, lympho-vascular/ perineural invasion, and duodenal/pancreatic invasion were significant risk factors for lymph node metastases. Macroscopically, non-exposed protruded- or ulcerative-type disease did not correlate directly with lymph node metastases; however, these tumor types were associated with other invasive features. In a subset of early carcinomas fulfilling the conditions of exposed protruded adenoma or papillary/well-differentiated adenocarcinoma determined by endoscopic biopsy, negative duodenal invasion determined by endoscopic ultrasonography, no tumor infiltration into the pancreatic duct determined by intraductal ultrasound, and diameter of the pancreatic duct ≤3 mm determined by endoscopic retrograde cholangiopancreatography (N = 11), the incidence of lymph node metastasis and tumor infiltration into the pancreatic duct was 0%. Conclusion Strictly selected patients with early ampulla of Vater carcinomas may benefit from limited resection if the resected specimen is evaluated to confirm all histopathological criteria.

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