Adjuvant treatment in resected ampullary carcinoma with high risk of recurrence — pancreatobiliary or mixed subtype

Following surgical resection of an ampullary carcinoma, patients whose tumour carries high-risk pathological features require adjuvant treatment. This protocol applies specifically to those with pancreatobiliary (PB) or mixed (MT) histological subtype who are fit to receive systemic therapy.

Clinical scenario: Resected ampullary carcinoma meeting one or more high-risk criteria — pT3/T4, pN+, poor differentiation, or R1 resection margin — in patients of pancreatobiliary or mixed subtype who are fit for adjuvant chemotherapy.

Adjuvant chemotherapy is the evidence-based approach for this population. The standard consists of a 6-month course of monotherapy; an intensified polychemotherapy option may also be considered in selected fit patients. Full regimen selection, criteria, and sequencing are detailed in the complete protocol.

Instant Access to Structured Evidence-Based Regimens

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).
gemcitabine for PB or MT 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.
mFOLFIRINOX (irinotecan 150 mg/m²) is preferred for PB and MT subtype.

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