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References

Abstract

Background: In some Dutch pancreatic surgery centers, patients who underwent pancreatoduodenectomy (PD) for ampullary cancer undergo surveillance for colorectal cancer (CRC), since an association is suggested in contemporary literature. This study aimed to examine the CRC incidence after PD for ampullary cancer in four pancreatic surgery centers and a Dutch nationwide cohort. Methods: All patients who underwent resection of ampullary cancer from 2005 through 2017 at four centers were included. All colonoscopies and CRC diagnoses in these patients were recorded. In addition all PDs for ampullary cancer in the Dutch Pathology Registry (2000-2017) were recorded along with the CRC diagnoses and compared with an age, sex, and year-matched cohort. Results: Out of 287 included patients by the four centers, 11% underwent a colonoscopy within one year after PD. Eight (2.7%) were diagnosed with CRC before PD and two (0.7%), at 14 and 72 months after PD. In the nationwide cohort comparison, the CRC incidence was similar before (2.6% versus 1.9%, P = 0.424) and after surgery (2.1% versus 3.1%, P = 0.237). Within one year after PD, the incidence was 0.3% compared to 0.6% in the matched controls (P = 0.726) Conclusions: The current study could not find an increased risk of CRC in patients with resected ampullary cancer. Therefore, there is insufficient justification to screen for CRC in patients with resected ampullary cancer.

Introduction

Ampullary cancer is a rare malignancy that accounts for approximately 0.2% of all gastrointestinal cancers.[1] Due to its origin distal to the bile and pancreatic duct confluence at the duodenal outflow, the onset of symptoms (e.g. biliary obstruction) is early compared to most other periampullary and pancreatic tumors. As a consequence, resection rates of ampullary cancers reach up to 92%[2] and the reported 5-year survival rates range from 38 to 67%.[3-5] Several reports have suggested an increased incidence of colorectal polyps and malignancies in patients with ampullary cancer. Ampullary cancer in some patients is associated with hereditary colorectal cancer (CRC) syndromes, such as hereditary non-polyposis colorectal cancer (HNPCC) [6] and familial adenomatous polyposis (FAP).[7-9] However, in ampullary cancer patients without these syndromes, the CRC incidence is also reported to be higher than in age-adjusted control groups.[10, 11] This association has led to colorectal surveillance in patients who underwent pancreatoduodenectomy (PD) for ampullary cancer in some pancreatic cancer centers in the Netherlands. The yield of routine colonoscopy within one year after surgery is subject of debate.