Early-Stage Ampullary Cancer: Is Local Excision an Effective Alternative to Radical Resection? Journal Article

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Authors: Swanson, J; Littau, M; Tonelli, C; Cohn, T; Luchette, FA; Abdelsattar, Z; Baker, MS
Article Title: Early-Stage Ampullary Cancer: Is Local Excision an Effective Alternative to Radical Resection?
Abstract: BACKGROUND: The efficacy of local excision (transduodenal or endoscopic ampullectomy) in treating early-stage ampullary cancer has not been well defined. STUDY DESIGN: We queried the National Cancer Database to identify patients undergoing either local tumor excision or radical resection for early-stage (cTis-T2, N0, M0) ampullary adenocarcinoma between 2004 and 2018. Cox modeling was used to identify factors associated with overall survival. Patients undergoing local excision were then 1:1 propensity score-matched for demographics, hospital-level, and histopathological factors to those undergoing radical resection. Kaplan Meier method was used to compare overall survival (OS) profiles for matched cohorts. RESULTS: 1544 patients met inclusion criteria. 218 (14%) underwent local tumor excision; 1326 (86%) radical resection. On propensity score matching, 218 patients undergoing local excision were successfully matched to 218 patients undergoing radical resection. On comparison of matched cohorts, those undergoing local excision had lower rates of margin negative (R0) resection (85.1% vs 99%, p 0.001) and lower median lymph node counts (0 vs 13, p 0.001) but had significantly shorter lengths of initial hospitalization (median days: 1 vs 10 days, p 0.001), lower rates of 30-day readmission (3.3% vs 12.0%, p=0.001) and lower rates of 30-day mortality (1.8% vs 6.5%, p=0.016) than patients undergoing radical resection. There was no statistically significant difference in OS between the matched cohorts (46.9% vs 52.0%, p=0.46). CONCLUSION: In patients presenting with early-stage ampullary adenocarcinoma, local tumor excision is associated with higher rates of R1 resection but accelerated post-procedure recovery and patterns of OS comparable to those following radical resection.
Journal Title: Journal of the American College of Surgeons
ISSN: 1879-1190; 1072-7515
Publisher: Elsevier Inc  
Date Published: 2023