Endoscopic and Surgical Management of Non-Metastatic Ampullary Neuroendocrine Neoplasia: A Multi-Institutional Pancreas2000/EPC Study - Archive ouverte HAL Accéder directement au contenu
Article Dans Une Revue Neuroendocrinology Année : 2023

Endoscopic and Surgical Management of Non-Metastatic Ampullary Neuroendocrine Neoplasia: A Multi-Institutional Pancreas2000/EPC Study

Francesco Auriemma
  • Fonction : Auteur
Andrea Anderloni
Marco del Chiaro
  • Fonction : Auteur
Charles de Ponthaud
Yanis Dahel
Dominik Heling
  • Fonction : Auteur
Yosuke Inoue
  • Fonction : Auteur
William Jarnagin
  • Fonction : Auteur
Galen Leung
Alberto Mariani
  • Fonction : Auteur
Viliam Masaryk
  • Fonction : Auteur
Rainer Christoph Miksch
  • Fonction : Auteur
Nicolas Musquer
  • Fonction : Auteur
Bertrand Napoleon
  • Fonction : Auteur
Atsushi Oba
  • Fonction : Auteur
Stefano Partelli
  • Fonction : Auteur
Maria Petrone
  • Fonction : Auteur
Frédéric Prat
  • Fonction : Auteur
Alessandro Repici
  • Fonction : Auteur
Alain Sauvanet
Katrin Salzmann
  • Fonction : Auteur
Mark Schattner
  • Fonction : Auteur
Richard Schulick
  • Fonction : Auteur
Lilian Schwarz
Kevin Soares
  • Fonction : Auteur
François Souche
  • Fonction : Auteur
Stéphanie Truant
Jean Vaillant
  • Fonction : Auteur
Tiegong Wang
  • Fonction : Auteur
Edris Wedi
  • Fonction : Auteur
Jens Werner
  • Fonction : Auteur
Tobias Weismüller
Dörte Wichmann
  • Fonction : Auteur
Uwe Will
  • Fonction : Auteur
Piera Zaccari
Aiste Gulla
  • Fonction : Auteur
Christian Heise
  • Fonction : Auteur
Sara Regner
Sébastien Gaujoux

Résumé

Introduction: Ampullary neuroendocrine neoplasia (NEN) is rare and evidence regarding their management is scarce. This study aimed to describe clinicopathological features, management, and prognosis of ampullary NEN according to their endoscopic or surgical management. Methods: From a multi-institutional international database, patients treated with either endoscopic papillectomy (EP), transduodenal surgical ampullectomy (TSA), or pancreaticoduodenectomy (PD) for ampullary NEN were included. Clinical features, post-procedure complications, and recurrences were assessed. Results: 65 patients were included, 20 (30.8%) treated with EP, 19 (29.2%) with TSA, and 26 (40%) with PD. Patients were mostly asymptomatic (n = 46; 70.8%). Median tumor size was 17 mm (12–22), tumors were mostly grade 1 (70.8%) and pT2 (55.4%). Two (10%) EP resulted in severe American Society for Gastrointestinal Enterology (ASGE) adverse post-procedure complications and 10 (50%) were R0. Clavien 3–5 complications did not occur after TSA and in 4, including 1 postoperative death (15.4%) of patients after PD, with 17 (89.5%) and 26 R0 resection (100%), respectively. The pN1/2 rate was 51.9% (n = 14) after PD. Tumor size larger than 1 cm (i.e., pT stage >1) was a predictor for R1 resection (p < 0.001). Three-year overall survival and disease-free survival after EP, TSA, and PD were 92%, 68%, 92% and 92%, 85%, 73%, respectively. Conclusion: Management of ampullary NEN is challenging. EP should not be performed in lesions larger than 1 cm or with a endoscopic ultrasonography T stage beyond T1. Local resection by TSA seems safe and feasible for lesions without nodal involvement. PD should be preferred for larger ampullary NEN at risk of nodal metastasis.
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Dates et versions

hal-04544086 , version 1 (12-04-2024)

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Elias Karam, Marcus Hollenbach, Einas Abou Ali, Francesco Auriemma, Andrea Anderloni, et al.. Endoscopic and Surgical Management of Non-Metastatic Ampullary Neuroendocrine Neoplasia: A Multi-Institutional Pancreas2000/EPC Study. Neuroendocrinology, 2023, 113 (10), pp.1024-1034. ⟨10.1159/000531712⟩. ⟨hal-04544086⟩
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