Long-Term Efficacy And Safety Of Endoscopic Treatment For Early Duodenal Papillary Carcinoma

Objective To investigate the long-term outcomes and safety of endoscopic duodenal papillectomy and surgical treatment for early-stage cancer in duodenal papillary tumors.Methods We retrospectively reviewed electronic medical records of 48 patients with duodenal papillary tumor treated in Hangzhou First People’s Hospital from June 2012 to June 2021.We analyzed their histopathologic results,technical success rate,postoperative residual rate,recurrence rate and incidence of postoperative complications.Results（1）A total of 48 patients aged 49-88（74.2±9.1）years were included,including 28 males（58.3%）and 20 females（41.7%）.（2）Endoscopic papillectomy was successfully performed in all patients with lesions of 1.2-3.5cm in size,of which 46 patients were lumped and 2 were fragmented,and the intact removal rate was 95.8%（46/48）.（3）Preoperative biopsy results showed high-grade intraepithelial neoplasia in 38 cases,moderately differentiated adenocarcinoma in 4 cases,and highly differentiated adenocarcinoma in 6 cases;Postoperative pathology revealed 24 cases of high-grade intraepithelial neoplasia,9 cases of moderately differentiated adenocarcinoma,and 15 cases of highly differentiated adenocarcinoma.The accuracy rate of endoscopic biopsy was 70.8%（34/48）,and the missed diagnosis rate of duodenal papillary carcinoma was 58.3%（14/24）.（4）The incidence of early postoperative complications（within 1 month after EP operation）was 16.7%（8/48）,including 4 cases of acute pancreatitis（8.3%）,3 cases of delayed bleeding（6.3%）,and 1 case of acute cholangitis（2.1%）.The incidence of late postoperative complications（EP 1 month postoperatively）was 4.2%（2/48）,both of which were characterized by bile duct stenosis（4.2%）.（5）3 and 6 months after surgery,no tumor recurrence was found in endoscopic biopsy around the duodenal papilla,and the postoperative residual rate was 0%.（6）The mean postoperative follow-up time was 121.5 months（range 12-123 months）.Tumor recurrence occurred in 8 patients,the median time to recurrence was 17.5 months and the postoperative recurrence rate was 16.7%（8/48）.All patients were treated with endoscopic radiofrequency ablation.7 patients died during follow-up time.The 5-year survival rate was 91.7%,and the 10-year survival rate was 85.4%,the median progression-free survival（PFS）was 18.6 months（95%CI,12.1 to 25.1 months）,and the median overall survival（OS）was 121.5 months（95%CI,105.6 to 120.9 months）.Conclusion Endoscopic papillectomy is safe and effective in the treatment of early duodenal papillary carcinoma,especially as an alternative therapy for patients without surgical conditions.Long-term endoscopic follow-up and treatment are critical because of the risk of recurrence.