title: Feasibility of endoscopic papillectomy in early stage ampulla of Vater cancer.
abstract: OBJECTIVE
  Although endoscopic papillectomy has been attempted in early stage ampullary cancer (pTis, T1), its curative role and indications remain uncertain. The present study was designed to assess the factors that predict malignancy and lymph node metastasis and to suggest potential indications for endoscopic papillectomy by analyzing clinicopathological data.
  
  
  METHODS
  We performed a retrospective analysis of clinical and histopathological data of 216 patients with ampullary cancer between 1991 and 2006.
  
  
  RESULTS
  No tumor in pTis stage had metastasized to lymph nodes and only 9% of tumors in pT1 had metastasized. Tumor size (P = 0.018), depth of invasion (P = 0.021) and venous invasion (P = 0.014) were found to be significantly related to lymph node metastasis. Cases with early stage ampullary cancer of less than 2 cm with a well-differentiated histology and no angiolymphatic invasion (n = 13) showed no lymph node metastasis and no recurrence during a median follow up of 35.9 months.
  
  
  CONCLUSIONS
  Endoscopic papillectomy can be adopted as a viable alternative to surgery in patients with early stage ampullary cancer of less than 2 cm in size and with a well-differentiated histology. When a resected specimen has a well-differentiated histology, and there is no resection margin involvement and no angiolymphatic invasion, our findings indicate that subsequent radical surgery is unnecessary.
authors.affiliation: Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Sang Myung
authors.initials: SM
authors.lastname: Woo
authors.forename: Ji Kon
authors.initials: JK
authors.lastname: Ryu
authors.forename: Sang Hyub
authors.initials: SH
authors.lastname: Lee
authors.forename: Woo Jin
authors.initials: WJ
authors.lastname: Lee
authors.forename: Jin Hyok
authors.initials: JH
authors.lastname: Hwang
authors.forename: Ji Won
authors.initials: JW
authors.lastname: Yoo
authors.forename: Joo Kyung
authors.initials: JK
authors.lastname: Park
authors.forename: Gyeong Hoon
authors.initials: GH
authors.lastname: Kang
authors.forename: Yong-Tae
authors.initials: YT
authors.lastname: Kim
authors.forename: Yong Bum
authors.initials: YB
authors.lastname: Yoon
mesh_terms: D014670:Ampulla of Vater / Q000473:pathology / Q000601:surgery*; D002454:Cell Differentiation; D003138:Common Bile Duct Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016145:Endoscopy, Digestive System; D005240:Feasibility Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008207:Lymphatic Metastasis; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D018579:Patient Selection; D016016:Proportional Hazards Models; D012008:Recurrence; D012189:Retrospective Studies; D018570:Risk Assessment; D013997:Time Factors; D016896:Treatment Outcome