title: Can endoscopic resection be applied for early stage ampulla of Vater cancer?
abstract: 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.
authors.affiliation: Department of Internal Medicine, Konkuk University College of Medicine, Seoul, Korea.
authors.forename: Sun-Young
authors.initials: SY
authors.lastname: Lee
authors.forename: Kee-Taek
authors.initials: KT
authors.lastname: Jang
authors.forename: Kyu Taek
authors.initials: KT
authors.lastname: Lee
authors.forename: Jong Kyun
authors.initials: JK
authors.lastname: Lee
authors.forename: Seong Ho
authors.initials: SH
authors.lastname: Choi
authors.forename: Jin Seok
authors.initials: JS
authors.lastname: Heo
authors.forename: Seung Woon
authors.initials: SW
authors.lastname: Paik
authors.forename: Jong Chul
authors.initials: JC
authors.lastname: Rhee
mesh_terms: 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