Treatment after Resection of Ampullary Carcinoma with High Risk of Recurrence — Intestinal Subtype, Fit Patient
After curative-intent resection of ampullary carcinoma, certain pathological findings identify patients at substantially elevated risk of disease recurrence. Fit patients in this setting require structured adjuvant management guided by subtype-specific evidence.
Clinical scenario
- Resected ampullary carcinoma with at least one high-risk feature: pT3/T4 stage, lymph node involvement (pN+), poor tumour differentiation, or positive resection margins (R1)
- Intestinal (INT) histological subtype
- Fit patient eligible for adjuvant treatment
Treatment approach
Current evidence supports adjuvant chemotherapy for fit patients in this high-risk setting, with the choice of regimen — monotherapy or a combination approach — informed by the intestinal subtype and individual patient factors.
The specific agents, sequencing, and full decision algorithm are detailed in the complete structured protocol.
References
DOI: 10.1016/j.dld.2024.04.027
- Adjuvant chemotherapy should be administered to fit patients, with a high risk of recurrence (pT3/T4 or pN+ or poor differentiation or R1 AC) and with a strict management of toxicities (expert agreement).
- 5FU or capecitabine for INT subtype
- Adjuvant monotherapy for 6 months (gemcitabine or simplified LV5FU2 or capecitabine) has the highest level of evidence (grade B) and is therefore the standard treatment for adjuvant chemotherapy.
- As the prognosis of INT subtype is better, FOLFOX or CAPOX is preferred for INT subtype
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