Long‐term outcomes of endoscopic papillectomy for early‐stage cancer in duodenal ampullary adenoma: Comparison to surgical treatment

Background and Aim While recent evidences support endoscopic resection as curative in ampullary tumors with high‐grade intraepithelial neoplasia, only small case series have reported endoscopic management of early‐stage ampullary cancer; thus, radical surgery remains the only accepted treatment modality. We evaluated the long‐term outcomes of early ampullary adenocarcinoma administered endoscopic management. Methods We retrospectively reviewed electronic medical records of 715 patients undergoing endoscopic papillectomy (EP) in a single tertiary medical center in Korea in 2004–2016. We included patients incidentally diagnosed with early‐stage adenocarcinoma (Tis and T1a, American Joint Committee on Cancer 8th edition) after EP and with >2 years of follow‐up data and analyzed their demographics, histopathologic data, and clinical outcomes. Results Among 70 total patients in the EP‐alone (n = 42) and subsequent surgery (n = 28) groups, we observed no significant differences in demographics or tumor size (2.0 ± 0.6 vs 1.9 ± 0.5 cm, P = 0.532), histologic grade (P = 0.077), tumor extent (P = 1.000), lymphovascular invasion (2.4% vs 10.7%, P = 0.344), or complete resection rates (57.1% vs 57.1%, P = 1.000) between groups. Adenocarcinoma lesions were larger in the subsequent surgery group (0.7 ± 0.5 vs 1.1 ± 0.7 cm, P = 0.002). The EP‐alone group received more additional ablative treatment (42.9% vs 14.3%, P = 0.024). The 5‐year disease‐free and cancer‐free survival rates were 79.1% vs 87.4% (P = 0.111) and 93.5% versus 87.4% (P = 0.726), respectively, and did not differ significantly between groups. Conclusions Endoscopic papillectomy followed by endoscopic surveillance showed long‐term outcomes comparable with surgical resection for early ampullary cancer and maybe curable alternative to surgery for incidentally found early‐stage ampullary cancer, especially in patients unfit for or refusing radical surgery.