Ampullary Carcinoma Staged pTis or pT1a with R0 Resection — Treatment Approach
This protocol addresses early-stage ampullary adenocarcinoma where the tumour is confined to pTis or pT1a, an R0 resection is achievable, and — in the case of pT1a — no worrisome histological features are present and lymph node involvement has been excluded.
Clinical Scenario
Ampullary carcinoma staged pTis or pT1a; R0 resection achievable. For pT1a specifically: no poor differentiation, no lymphovascular involvement, no high tumour budding, and no lymph node involvement on pre-operative staging.
Treatment Approach — Partial Overview
Management in this setting centres on a major surgical resection of the pancreaticoduodenal region. The complete protocol defines when and how this procedure is indicated, the staging workup required, and the criteria that determine operative fitness.
Full criteria, decision thresholds, and the complete management algorithm are in the structured protocol 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
- 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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