Treatment of Ampullary Adenocarcinoma Staged pTis or pT1a with R0 Resection and No High-Risk Features
This protocol applies to early ampullary carcinoma (pTis or pT1a) where complete (R0) resection is achievable, pathological risk features are absent, and there is no lymph node involvement.
Clinical Scenario
- Ampullary carcinoma staged pTis or pT1a
- R0 resection achievable
- For pT1a: no worrisome features — no poor differentiation, no lymphovascular involvement, no high tumour budding
- No lymph node involvement
Approach
Management in this setting focuses on local resection of the ampullary lesion with the goal of complete en-bloc removal and clear margins. The full protocol defines the preferred resection method and the conditions under which an alternative surgical approach applies.
Complete technique selection criteria and protocol details are available via the link below.
References
DOI: 10.1016/j.dld.2024.04.027
- It might also be sufficient for pTis AC and for pT1a AC not suitable for surgery, the latter having a very low risk of lymph node metastasis when harboring no other risk factors (well differentiated, R0 resection, no lymphovascular involvement or tumor budding).
- pTis and R0 AC
- pT1a AC and R0 resection (either endoscopic or surgical) without worrisome features and no fit enough for pancreaticoduodenectomy
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