Systematic review with meta-analysis: endoscopic and surgical resection for ampullary lesions

Introduction Ampullary lesions (ALs) can be treated by endoscopic ampullectomy (EA), surgical ampullectomy (SA) or pancreaticoduodenectomy (PD). However, EA reveals significant risk of incomplete resection while surgical interventions lead to substantial morbidity.

Methods We performed a systematic review and meta-analysis to compare R0 resection rate, adverse events (AEs) and recurrence between EA, SA and PD for non-invasive and T1 ampullary tumors. Electronic databases (Medline, EMBASE, SCOPUS) were searched for publications analyzing ALs from 1990 to 2018. R0, AEs and recurrence were calculated as pooled means using a fixed and random-effects model and transformed into a quantity using the Freeman-Tukey Double Arcsine Proportion model. Comparisons were performed by two-sided Student’s t-test.

Results We identified 59 independent studies. The pooled R0 rate was 76.6 % (71.8 %-81.4 %, I² = 91.38 %) for EA, 96.4 % (93.6 %-99.2 %, I² = 37.8 %) for SA and 98.9 % (98.0 %-99.7 %, I²=0 %) for PD. AEs were 24.7 % (19.8 %-29.6 %, I² = 86.4 %) for EA, 28.3 % (19.0 %-37.7 %, I²=76.8 %) for SA and 44.7 % (37.9 %-51.4 %, I² = 0 %) for PD. Recurrences were registered in EA in 13.0 % (10.2 %-15.6 %, I² = 91.3 %), in SA in 9.4 % (4.8 %-14 %, I² = 57.3 %) and in PD in 14.2 % (9.5 %-18.9 %, I²=0 %). Differences between proportions were significant in R0 for EA compared to SA (p = 0.007) and PD (p = 0.022). AEs were statistically different only between EA and PD (P = 0.049) and recurrence showed no significance for EA/SA or EA/PD.

Conclusion Our data indicate an increased rate of complete resection in surgical interventions accompanied with a higher risk of complications. However, studies showed various sources of bias, limited quality of data and a significant heterogeneity, particularly in EA-studies.

Publication History

Article published online:
08 September 2020