Long-Term Outcomes Following Endoscopic Papillectomy for Ampullary Neuroendocrine Tumors

The role of endoscopic papillectomy (EP) for ampullary neuroendocrine tumors (Amp-NETs) remains uncertain due to concerns regarding lymph node (LN) metastasis and recurrence. This study evaluated the long-term outcomes of EP for Amp-NETs, focusing on recurrence and procedural safety.

Patients with histologically confirmed Amp-NETs who underwent EP at a single tertiary center between 2004 and 2018 were retrospectively reviewed. Inclusion criteria were tumor size < 3 cm and absence of radiologic evidence of LN or distant metastasis. Outcomes assessed included recurrence, procedure-related adverse events, and recurrence-free survival (RFS).

Thirty-four patients were included. En bloc resection was achieved in 33 patients (97.1%), while complete resection was achieved in 19 patients (55.9%). Over a median follow-up of 68.5 months, recurrence occurred in three patients (9.1%). All recurrences occurred exclusively in patients with positive resection margins (20%, 3/15), whereas no recurrence was observed in margin-negative patients (0%, 0/19). Early adverse events occurred in 13 patients (38.2%; bleeding n = 12, pancreatitis n = 3), while late adverse events developed in 4 patients (11.8%; papillary stricture), all of which were managed successfully with endoscopic treatment.

EP is a safe and effective option for small, well-differentiated Amp-NETs without radiologic evidence of LN metastasis. Although the incomplete resection rate is concerning, the absence of recurrence in margin-negative patients supports EP as a viable treatment option in carefully selected cases. Patients with positive margins warrant close surveillance and consideration of additional surgery.