Treatment of Ampullary Adenocarcinoma at pT1b or Higher Stage — or pT1a with Worrisome Features — in Fit Patients

When ampullary carcinoma (AC) reaches a higher pathological stage, or when early-stage disease carries high-risk histological or imaging findings, a more definitive surgical management strategy is required. This protocol applies to fit patients in whom papillectomy alone is insufficient.

Clinical scenario

Ampullary carcinoma at pT1b or higher stage
pT1a AC with worrisome histological or imaging features: suspected lymph node involvement, R1 resection, poor differentiation, lymphovascular involvement, or high tumour budding
Patient fit for major surgical intervention

Management approach

Current evidence-based guidelines specify a defined major surgical procedure as the mandatory standard of care for patients meeting any of the above criteria. The complete protocol details the operative approach, the role of pre-operative imaging evaluation, and the full evidence base.

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References

DOI: 10.1016/j.dld.2024.04.027

pT1b or higher stage AC
Over pT1a AC or AC with histological worrisome features (poor differentiation, lymphovascular involvement, high budding tumor) or in case of R1 resection not manageable with surgical papillectomy or lymph node involvement after the initial evaluation (EUS, CT-scan or MRI), pancreatoduodenectomy is mandatory for fit patients.

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