Surgical outcomes of transduodenal ampullectomy for early-stage ampullary carcinoma: a comparative analysis with pancreaticoduodenectomy.

Background/aims: Transduodenal ampullectomy (TDA) has been applied in selected cases of early ampullary carcinoma as a less invasive alternative to pancreaticoduodenectomy (PD). This study compared perioperative and oncologic outcomes between TDA and PD in patients with early-stage ampullary cancer. Methods: Patients who underwent curative-intent resection for ampullary carcinoma (Tis/high-grade dysplasia, T1, and T2) between August 2017 and February 2025 were retrospectively reviewed. Tumor staging was standardized according to the AJCC 8th edition. Clinicopathologic characteristics and surgical outcomes were analyzed between the TDA and PD groups. Results: Twenty-eight patients underwent TDA, and 35 underwent PD. The TDA group showed significantly shorter operative time, lower estimated blood loss, shorter postoperative hospital stay, and reduced overall complication rate. The incidence of clinically relevant postoperative pancreatic fistula was significantly lower after TDA. Lymph node metastasis was identified in 20.0% of the TDA group and 21.2% of the PD group. Five-year disease-free survival rates were comparable between the two groups in the T1 subgroup analysis. Conclusions: In carefully selected patients with Tis/HGD and T1 ampullary carcinoma, TDA combined with lymph node dissection provides favorable perioperative outcomes and comparable long-term disease control relative to PD. For T2 disease, PD remains the standard of care, while TDA may be considered only in highly selected cases unfit for radical surgery.