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- W2894640323 abstract "Introduction: We have emphasized the complications and uncertain pathological evaluation of the margins after endoscopic papillectomy, and reported the usefulness of limited surgical resection, such as transduodenal papillectomy (TDP), or extraduodenal papillectomy (ExDP). The aim of this study is to determine the indications for limited resection of ampullary neoplasms (NAV). Methods: From 1992 to 2017, 121 patients with NAV underwent resection. 22 patients (18%, 15 males, mean age 66.4y) underwent limited resection (15 TDP and 7 ExDP). Results: Endoscopic ultrasonography (EUS) and/or intraductal ultrasonography (IDUS) were performed preoperatively in all patients and no pancreatic, duodenal or biliary invasion was detected. Pathologically, 10 adenomas and 12 adenocarcinomas including nine mucosal carcinomas, two od-carcinomas (limited to the sphincter of Oddi) and one T2 carcinoma (duodenal invasion) were confirmed. All adenomas had negative surgical margins. Two mucosal carcinomas had positive margins at the bile duct and pylorus preserving pancreatoduodenectomy (PpPD) was performed. One od-carcinoma underwent PpPD, as 24% of od-carcinomas had nodal metastases in our previous series. The one T2 carcinoma underwent PpPD. Pathological evaluation showed residual carcinoma in two of four additional PpPD cases, but no nodal metastases. All patients are alive without recurrence. Conclusion: NAVs often have mucosal spread into the biliary or pancreatic ducts, which cannot be detected by preoperative EUS or IDUS. Limited resection for NAV allows precise pathological evaluation especially for early stage lesions. A “step-up” strategy with limited resection as the primary procedure followed by PpPD after pathological evaluation is feasible for the treatment of early-stage NAVs." @default.
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- W2894640323 date "2018-09-01" @default.
- W2894640323 modified "2023-09-26" @default.
- W2894640323 title "Step-up strategy with limited resection for early stage neoplasms of the ampulla of vater" @default.
- W2894640323 doi "https://doi.org/10.1016/j.hpb.2018.06.1493" @default.
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