Clinical outcomes of ampullary neoplasms in resected margin positive or uncertain cases after endoscopic papillectomy

Table 1 Histopathological findings of primary tumor invasion (according to the Classification of Biliary Tract Cancers established by the Japanese Society of Hepato-Biliary-Pancreatic Surgery: 3^rd English edition)

Tis	Carcinoma in situ
T1a	Tumor limited to mucosa
T1b	Tumor limited to sphincter of Oddi
T2	Tumor invades duodenal wall
T3a	Tumor invades pancreas within 5 mm in depth
T3b	Tumor invades pancreas beyond 5 mm in depth
T4	Tumor invades peripancreatic soft tissues, or other adjacent organs or structures

Table 2 The characteristics of all patients

Number of all EP cases	45
Male/female	29/16
Age (yr, mean ± SD)	65.0 ± 11.5
Tumor size (mm, mean ± SD)	21.1 ± 6.2
En-bloc resection/piecemeal resection	41/4
Stent placement
Both/pancreatic/biliary/none	33/7/4/1
Complications of EP
Post-EP bleeding	9 (20.0%)
Post-EP pancreatitis	13 (28.9%)
Hospital stay (d, mean ± SD)	15.4 ± 8.5
Pathological diagnosis
Adenoma/adenocarcinoma	33/12
Pathological evaluation of resected margin
Positive/uncertain/negative	12/12/21
Horizontal margin
Positive/uncertain	9/10
Vertical margin
Positive/uncertain	5/9
Median observation period (mo, range)	27.1 (3.0-133.4)

EP: Endoscopic papillectomy.

Table 3 The diagnostic accuracy of endoscopic forceps biopsy before endoscopic papillectomy

Preoperative biopsy	Number	Final pathological diagnosis
		Adenoma	Adenocarcinoma
Adenoma	30	28	2
Borderline	11	4	7
Adenocarcinoma	4	1	3

Table 4 Summary of the clinical data of the patients who developed recurrent tumors after endoscopic papillectomy

Age	Sex	Preoperative diagnosis	Final diagnosis	Size (mm)	Resection margin	Duration to recurrence (mo)	Additional treatment	Follow up periods after APC (mo)
75	Male	Adenoma	Adenoma	25	HM (+), VM (X)	1.0	APC	75.9
60	Female	Adenoma	Adenoma	17	HM (+), VM (X)	5.0	APC	133.4
73	Male	Borderline	Adenocarcinoma	22	HM (+), VM (-)	1.2	APC	56.6
74	Female	Adenoma	Adenoma	n/d	HM (-), VM (-)	6.3	APC	71.0

APC: Argon plasma coagulation.