Retrospective Cohort Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Mar 26, 2019; 7(6): 717-726
Published online Mar 26, 2019. doi: 10.12998/wjcc.v7.i6.717
Surgical method choice and coincidence rate of pathological diagnoses in transduodenal ampullectomy: A retrospective case series study and review of the literature
Feng Liu, Jia-Lin Cheng, Jing Cui, Zong-Zhen Xu, Zhen Fu, Ju Liu, Hu Tian
Feng Liu, Jia-Lin Cheng, Zong-Zhen Xu, Zhen Fu, Hu Tian, Department of General Surgery, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan 250014, Shandong Province, China
Jia-Lin Cheng, Taishan Medical University, Tai’an 271016, Shandong Province, China
Jing Cui, Department of Pathology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan 250014, Shandong Province, China
Ju Liu, Medical Research Center, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan 250014, Shandong Province, China
Author contributions: Tian H, Liu F, and Cheng JL designed the study and wrote the paper; Tian H, Liu F, Xu ZZ, and Cheng JL performed the surgery; Liu F, Cheng JL, Cui J, Fu Z, and Liu J collected the patients’ clinical data and performed the statistical analysis; all authors have read and approved the final version of this manuscript.
Supported by the Key Research and Development Plan of Shandong Province, No. 2016GSF201108.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of Shandong Provincial Qianfoshan Hospital.
Informed consent statement: All clinical data were collected with informed consent obtained from study participants.
Conflict-of-interest statement: The authors of this manuscript have no conflicts of interest to disclose.
STROBE Statement: This report is presented as suggested by the STROBE statement, i.e., according to the guidelines for reporting observational studies.
Open-Access: This article is an open-access article which 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: Hu Tian, MD, PhD, Chief Doctor, Professor, Surgeon, Department of General Surgery, Shandong Provincial Qianfoshan Hospital, Shandong University, No. 16766, Jingshi Road, Jinan 250014, Shandong Province, China. tianhu6585@163.com
Telephone: +86-531-89269817 Fax: +86-531-82963647
Received: November 15, 2018
Peer-review started: November 16, 2018
First decision: December 29, 2018
Revised: January 23, 2019
Accepted: February 26, 2019
Article in press: February 26, 2019
Published online: March 26, 2019
Processing time: 131 Days and 11.2 Hours
ARTICLE HIGHLIGHTS
Research background

Transduodenal ampullectomy (TDA) is not in wide clinical use due to its low radical effect and a high recurrence rate of tumors. However, TDA is still an effective treatment method that has great clinical value in cases of duodenal benign tumors, precancerous lesions, and benign and malignant borderline tumors; it can avoid the risks associated with pancreaticoduodenectomy (PD) and offers a larger resection range and greater thoroughness than endoscopic papillectomy (EP).

Research motivation

The investigation of surgical method choice and the coincidence rate of pathological diagnoses in TDA can improve our understanding of TDA. TDA is still an effective treatment method and is of great clinical value in cases of duodenal benign tumors, precancerous lesions, and benign and malignant borderline tumors.

Research objectives

The main objective of this study was to investigate surgical method choice and the coincidence rate of pathological diagnoses in TDA.

Research methods

Ten patients with ampullary neoplasm underwent TDA based on the fact that the endoscopic biopsy results suggested benign lesions and the endoscopic ultrasound (EUS)-assessed tumors were resectable. All cases underwent duodenal ampullary lesion endoscopic biopsy, intraoperative frozen-section pathology, and postoperative pathological examination.

Research results

There were seven patients with benign tumors and three with malignant tumors (1 pTis, 2 pT1) according to the postoperative pathology results. The coincidence rate of the postoperative pathology results with the intraoperative frozen-section biopsy results was 100% (10/10), and the coincidence rate with the endoscopic biopsy results based on pathological characteristics was 70% (7/10). The false-negative rate of endoscopic biopsy results was 30% (3/10). All patients were followed for 6 to 70 months without tumor recurrence or metastasis.

Research conclusions

The coincidence rate of postoperative pathology results, intraoperative frozen-section pathology results, and endoscopic biopsy results is the restraining factor of TDA clinical application. Endoscopic biopsy results and EUS are an importance reference for surgical planning. Intraoperative frozen-section pathology results have a significant influence on the surgical procedure.

Research perspectives

Due to the small sample size and the retrospective nature of the study, it is difficult to draw reliable conclusions. However, TDA is still an effective treatment method that has great clinical value in cases involving duodenal benign tumors, precancerous lesions, and benign and malignant borderline tumors. Based on the coincidence rate of postoperative pathology results, intraoperative frozen-section pathology results, and endoscopic biopsy results, TDA can be considered as a treatment choice between EP and radical PD.