Copyright
©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
Clinical outcomes of ampullary neoplasms in resected margin positive or uncertain cases after endoscopic papillectomy
Arata Sakai, Masahiro Tsujimae, Atsuhiro Masuda, Takao Iemoto, Shigeto Ashina, Kohei Yamakawa, Takeshi Tanaka, Shunta Tanaka, Yasutaka Yamada, Ryota Nakano, Yu Sato, Manabu Kurosawa, Takuya Ikegawa, Seiji Fujigaki, Takashi Kobayashi, Hideyuki Shiomi, Yoshifumi Arisaka, Tomoo Itoh, Yuzo Kodama
Arata Sakai, Masahiro Tsujimae, Atsuhiro Masuda, Takao Iemoto, Shigeto Ashina, Kohei Yamakawa, Takeshi Tanaka, Shunta Tanaka, Yasutaka Yamada, Ryota Nakano, Yu Sato, Manabu Kurosawa, Takuya Ikegawa, Seiji Fujigaki, Takashi Kobayashi, Hideyuki Shiomi, Yoshifumi Arisaka, Yuzo Kodama, Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan
Takao Iemoto, Department of Gastroenterology, Kita-Harima Medical Center, Ono, Hyogo 675-1392, Japan
Yoshifumi Arisaka, Department of Gastroenterology, Nippon Life Hospital, Osaka 550-0006, Japan
Tomoo Itoh, Department of Diagnostic Pathology, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan
Author contributions: Sakai A and Masuda A designed the study, analyzed the data, and drafted the manuscript; Tsujimae M and Iemoto T collected the data; Kodama Y gave the final approval of the manuscript; All the other authors revised the manuscript and approved the final version of the manuscript.
Institutional review board statement: This study was conducted with the approval of the ethics committee of Kobe University Graduate School of Medicine, IRB No. 170057.
Informed consent statement: Patients were not required to give informed consent to the study because this retrospective study used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: There are no conflicts of interest.
Data sharing statement: No additional data are available.
Open-Access: This is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Atsuhiro Masuda, MD, PhD, Assistant Professor, Doctor, Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo 650-0017, Japan. atmasuda@med.kobe-u.ac.jp
Telephone: +81-78-3826305 Fax: +81-78-3826309
Received: December 13, 2018
Peer-review started: December 13, 2018
First decision: January 30, 2019
Revised: February 6, 2019
Accepted: February 15, 2019
Article in press: February 15, 2019
Published online: March 21, 2019
ARTICLE HIGHLIGHTS
Research background
The clinical outcomes of resected margin positive or uncertain cases after endoscopic papillectomy (EP) remains unknown.
Research motivation
The post-EP resection margins of ampullary tumors are often positive or uncertain because of the burning effect of EP. The clinical outcomes of resected margin positive or uncertain cases after EP remains unknown. Decisions regarding the treatment course in such cases might differ among institutions and/or depend on each patient’s condition.
Research objectives
To investigate the clinical outcomes of resected margin positive or uncertain cases after EP.
Research methods
Forty-one patients with ampullary tumors who underwent EP at Kobe University Hospital between January 2007 and October 2018 were included in this study. The clinical outcomes of each EP cases were retrospectively investigated.
Research results
The resected margins were positive or uncertain in 24 patients (53.3%). Of these cases, 15 and 9 were diagnosed as adenoma and adenocarcinoma, respectively. Local tumor recurrence was detected in 3 cases. All of the recurrent tumors were successfully treated with argon plasma coagulation (APC). There was no local or lymph node recurrence after the APC. The post-APC follow-up periods lasted for 57.1 mo to 133.8 mo. No ampullary tumor-related deaths occurred in all patients.
Research conclusions
In conclusion, resected margin positive or uncertain cases after EP could be managed by endoscopic treatment including APC, even in cases of adenocarcinoma.
Research perspectives
Our results might help to determine appropriate indications for EP, including for cases of early stage ampullary carcinoma. A further large-scale prospective study will be needed in the future.
