Can endoscopic resection be applied for early stage ampulla of Vater cancer?

Background Although endoscopic resection can provide a wide tumor resection with a negative resection margin, it is not yet recommended as a curative therapy for ampulla of Vater cancer. Here, we investigated the microinvasion rate and the diagnostic accuracy of endoscopic biopsy to properly judge t...

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Bibliographic Details
Published in:Gastrointestinal endoscopy 2006-05, Vol.63 (6), p.783-788
Main Authors: Lee, Sun-Young, MD, Jang, Kee-Taek, MD, Lee, Kyu Taek, MD, Lee, Jong Kyun, MD, Choi, Seong Ho, MD, Heo, Jin Seok, MD, Paik, Seung Woon, MD, Rhee, Jong Chul, MD
Format: Article
Language:English
Subjects:
Aged
Ampulla of Vater
Biological and medical sciences
Common Bile Duct Neoplasms - mortality
Common Bile Duct Neoplasms - pathology
Common Bile Duct Neoplasms - surgery
Female
Gastroenterology and Hepatology
Gastroenterology. Liver. Pancreas. Abdomen
Humans
Lymphatic Metastasis
Male
Medical sciences
Middle Aged
Neoplasm Invasiveness
Neoplasm Staging
Prognosis
Retrospective Studies
Sphincter of Oddi
Sphincterotomy, Endoscopic
Survival Analysis
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Summary:Background Although endoscopic resection can provide a wide tumor resection with a negative resection margin, it is not yet recommended as a curative therapy for ampulla of Vater cancer. Here, we investigated the microinvasion rate and the diagnostic accuracy of endoscopic biopsy to properly judge the safety of endoscopic resection for ampulla of Vater cancer. Methods A total of 159 patients who were finally diagnosed with ampulla of Vater cancer after curative surgical resection were included in this retrospective study. We surveyed the pathologic concordance rate of endoscopic biopsy and the surgical pathology. For the 36 early stage (Tis or T1) cancers, we surveyed the presence of microlymphovascular invasion, gross appearance (intra-ampullary type, periampullary type, or mixed type), and pathologic subtype (intestinal type or pancreaticobiliary type). Results Endoscopic biopsy failed to reveal malignancy in 15.9% of the 126 cases. Microlymphovascular invasion was present in 17 cases (56.7%) of the 30 T1 cancers but was absent in all cases of the 6 Tis cancers ( p = 0.02). Neither the gross appearance ( p = 0.51) nor the pathologic subtype ( p = 0.28) could predict the microinvasion rate. Conclusions Although endoscopic resection improves the low predictability of endoscopic biopsy, surgical resection should be performed for the T1 stage ampulla of Vater cancer because of the high lymphovascular invasion rate. On the other hand, the safety of endoscopic resection should be evaluated by a large-scale study on Tis cancers for considering the absence of microinvasion.
ISSN:0016-5107
1097-6779
DOI:10.1016/j.gie.2005.09.015