Principles of Management of Patients With Ampullary Adenocarcinoma

Presenter: Stephen W. Behrman

Ampullary adenocarcinoma is an uncommon neoplasm that most often requires pancreatoduodenectomy, has a less than optimal cure rate, and is a cancer for which the impact of multidisciplinary care remains unclear. Although often believed to have a better prognosis than pancreatic cancer, ampullary cancer remains a highly lethal disease. Given its rarity and the typical lack of surrounding vessel invasion, a surgery-first approach has most commonly been used in treatment sequencing. The literature has yielded conflicting results regarding the use of adjuvant therapy. Neoadjuvant therapy has received little attention but offers promise with regard to pathologic downstaging, particularly when chemotherapy is combined with radiation. Genetic evaluation may help guide future therapies, and multi-institutional trials are needed to develop optimal treatment sequencing and directed at the 2 specific histologic subtypes.

Disclosures: Dr. Behrman has disclosed no relevant financial relationships.

Correspondence: Stephen W. Behrman, MD, The University of Tennessee Health Science Center, 80 Humphreys Center, Suite 201, Memphis, TN 38120. Email: sbehrman@uthsc.edu
  • 1.

    Park W, Chawla A, O’Reilly EM, et al. Pancreatic cancer: a review [published correction appears in JAMA 2021;326:2081]. JAMA 2021;326:851862.

  • 2.

    Stiles ZE, Behrman SW, Deneve JL, et al. Ampullary adenocarcinoma: defining predictors of survival and the impact of adjuvant therapy following surgical resection for stage I disease. J Surg Oncol 2018;117:15001508.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 3.

    Moekotte AL, van Roessel S, Malleo G, et al. Development and external validation of a prediction model for survival in patients with resected ampullary adenocarcinoma. Eur J Surg Oncol 2020;46:17171726.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4.

    Ecker BL, Vollmer CM Jr, Behrman SW, et al. Role of adjuvant multimodality therapy after curative-intent resection of ampullary carcinoma. JAMA Surg 2019;154:706714.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5.

    Nassour I, Hynan LS, Christie A, et al. Association of adjuvant therapy with improved survival in ampullary cancer: a national cohort study. J Gastrointest Surg 2018;22:695702.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6.

    Ramaswamy A, Bhandare M, Bal M, et al. Clinico-pathological correlates and survival outcomes in 214 resected ampullary adenocarcinomas: are outcomes different in intestinal and pancreatobiliary subtypes with adjuvant gemcitabine? HPB (Oxford) 2020;22:376382.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 7.

    Al Abbas AI, Falvello V, Zenati M, et al. Impact of adjuvant chemotherapy regimen on survival outcomes in immunohistochemical subtypes of ampullary carcinoma [published online December 15, 2019]. J Surg Oncol, doi: 10.1002/jso.25808

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8.

    Vo NP, Nguyen HS, Loh EW, et al. Efficacy and safety of adjuvant therapy after curative surgery for ampullary carcinoma: a systematic review and meta-analysis. Surgery 2021;170:12051214.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9.

    Yamashita S, Overman MJ, Wang H, et al. Pathologic response to preoperative therapy as a novel prognosticator for ampullary and duodenal adenocarcinoma. Ann Surg Oncol 2017;24:39543963.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10.

    Guo M, Beal EW, Miller ED, et al. Neoadjuvant therapy versus surgery first for ampullary carcinoma: a propensity score-matched analysis of the NCDB. J Surg Oncol 2021;123:15581567.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11.

    Wong W, Lowery MA, Berger MF, et al. Ampullary cancer: evaluation of somatic and germline genetic alterations and association with clinical outcomes. Cancer 2019;125:14411448.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
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