Oncologic effect of preoperative endoscopic sphincterotomy in patients undergoing pancreaticoduodenectomy for ampulla of vater cancer.

Purpose: Ampulla of Vater (AoV) cancer often presents with bile flow obstruction requiring bile drainage. Endoscopic sphincterotomy (EST) for AoV cancer may result in inflammation and spread of the tumor due to the abundant lymphatic channels and microvascular structures around the AoV, which may impact the postoperative and oncologic outcomes. This study aimed to evaluate the postoperative and oncological effects of EST on AoV cancer.

Methods: Medical records of 131 patients with AoV cancer who underwent pancreaticoduodeenectomy between 2011 and 2020 were reviewed. We compared the perioperative outcomes, overall survival, and disease recurrence in the patients.

Results: Approximately 71 patients underwent EST for preoperative biliary drainage, whereas 60 did not receive any procedure or underwent percutaneous transhepatic biliary drainage. No significant differences were observed in the 5-year overall survival rate (EST 69.9% vs. no EST 75.1%, P = 0.804) or the 5-year cumulative recurrence rate (EST 49.1% vs. no EST 56.8%, P = 0.855). However, in subgroup analysis using the T stage, EST was associated with reduced 5-year overall survival in the T3 and T4 stages (EST 34.8% vs. no EST 78.0%: P = 0.038).

Conclusion and discussion: Preoperative endoscopic intervention for AoV cancer did not affect oncologic outcomes. However, in the advanced stage, direct manipulation of cancer may result in lower overall survival, requiring careful consideration for preoperative biliary drainage.