What is an adequate surgical management for pTis and pT1 early ampullary carcinoma?

The aim of this study is to identify an adequate surgical management for early ampullary carcinoma (AC).

We retrospectively reviewed a total of 51 patients who underwent a curative pancreaticoduodenectomy (PD) for various stages of AC.

A pathological early AC was defined as pTis and pT1 in this study. Of the 51 AC patients, 7, 13, 17, 13 and 1 were confirmed to be pTis, pT1, pT2, pT3, and pT4, respectively. The incidence of lymph node metastasis in pTis and pT1 patients was 0% and 0%, respectively, while the incidence of lymphatic invasion was 0% and 38.5%, respectively. These two pathological factors significantly correlated with the advancement of tumor invasion. Multivariate analysis demonstrated that lymph node metastasis and lymphatic invasion were the only significant independent predictors of survival. In 20 early AC patients, tumor recurrence was detected in 2 (10%) cases in which the tumor stage was pT1, and lymphatic invasion was evident.

Although PD is the gold standard operation for all ACs, less invasive surgery, such as ampullectomy, could be indicated for patients with pTis AC following a strict preoperative evaluation of tumor staging.