Department of Gastroenterology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China.
Department of Pathology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China.
Surg Endosc. 2022 Jul;36(7):5183-5197. doi: 10.1007/s00464-021-08894-0. Epub 2022 Mar 14.
The relationship between the pathological classification and recurrence of duodenal papillary adenomas (DPAs) has not been elucidated. We studied the clinicopathological characteristics of DPAs with different pathological types and conducted long-term follow-up to explore its prognosis and identify methods for appropriate clinical management of DPAs.
In total, 95 DPA cases confirmed by postoperative pathology were enrolled, of which 58 underwent endoscopic papillectomy (EP) and 37 underwent pancreatoduodenectomy (PD). The cases were classified into three anatomical and two histomorphological types according to the histopathology and location of endoscopic features. We analyzed the clinicopathological characteristics of DPAs with different pathological types and investigated the factors associated with recurrence in the EP subgroup.
Although EP was associated with fewer adverse events, the complete resection rate was significantly lower (72.4% vs. 100.0%, p < 0.001) and the recurrence rate significantly higher than with PD (16.3% vs. 0.0%, p < 0.001). Among eight EP cases with recurrence, six had intra-DPA (75%). A positive resection margin (HR 23.67, 95% CI 6.42-87.27; p < 0.001) and MUC2-negative status (HR 3.47, 95% CI 1.16-10.40; p = 0.026) were independent risk factors for recurrence after EP.
We identified different pathological types within DPAs, which presented varying clinicopathological features. The majority of peri-DPAs and mixed-DPAs were of the intestinal type histologically and EP is the primary recommendation. However, intra-DPA was mainly of the pancreaticobiliary type, which tends to get positive resection margins; thus, surgical resection is more suitable.
十二指肠乳头腺瘤（DPA）的病理分类与复发之间的关系尚未阐明。我们研究了不同病理类型的 DPA 的临床病理特征，并进行了长期随访，以探讨其预后，并确定 DPA 合适的临床管理方法。
共纳入 95 例经术后病理证实的 DPA 病例，其中 58 例行内镜乳头切除术（EP），37 例行胰十二指肠切除术（PD）。根据组织病理学和内镜特征的位置，将病例分为三种解剖学和两种组织形态学类型。我们分析了不同病理类型的 DPA 的临床病理特征，并研究了 EP 亚组中与复发相关的因素。
尽管 EP 相关的不良事件较少，但完全切除率明显较低（72.4%比 100.0%，p<0.001），复发率明显高于 PD（16.3%比 0.0%，p<0.001）。在 8 例复发的 EP 病例中，有 6 例为 intra-DPA（75%）。阳性切缘（HR 23.67，95%CI 6.42-87.27；p<0.001）和 MUC2 阴性状态（HR 3.47，95%CI 1.16-10.40；p=0.026）是 EP 后复发的独立危险因素。
我们发现 DPA 内存在不同的病理类型，表现出不同的临床病理特征。大多数 peri-DPA 和混合-DPA 在组织学上为肠型，EP 是主要推荐方法。然而，intra-DPA 主要为胰胆管型，往往有阳性切缘；因此，手术切除更适合。
