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.


METHODS
To investigate the microinvasion rate and the diagnostic accuracy of endoscopic biopsy to properly judge the safety of endoscopic resection for ampulla of Vater cancer.


METHODS
Single-center, retrospective study.


METHODS
Academic medical center.


METHODS
One hundred fifty-nine patients who were finally diagnosed with ampulla of Vater cancer after curative surgical resection.


METHODS
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).


METHODS
Presence of microinvasion in early staged ampulla of Vater cancer.


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 = .02). Neither the gross appearance (P = .51) nor the pathologic subtype (P = .28) could predict the microinvasion rate.


CONCLUSIONS
Single-center, retrospective study with small number of patients.


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 to consider the absence of microinvasion.
Lee
Sun-Young
SY
Department of Internal Medicine, Konkuk University College of Medicine, Seoul, Korea.
Jang
Kee-Taek
KT
Lee
Kyu Taek
KT
Lee
Jong Kyun
JK
Choi
Seong Ho
SH
Heo
Jin Seok
JS
Paik
Seung Woon
SW
Rhee
Jong Chul
JC
D000368:Aged; D014670:Ampulla of Vater; D003138:Common Bile Duct Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D009803:Sphincter of Oddi; D016717:Sphincterotomy, Endoscopic; D016019:Survival Analysis