Management of ampullary neoplasms: A tailored approach between endoscopy and surgery

Francesca Panzeri, Stefano Crippa, Paola Castelli, Francesca Aleotti, Alessandro Pucci, Stefano Partelli, Giuseppe Zamboni, Massimo Falconi

Research output: Contribution to journalArticle

Abstract

Ampullary neoplasms, although rare, present distinctive clinical and pathological features from other neoplastic lesions of the periampullary region. No specific guidelines about their management are available, and they are often assimilated either to biliary tract or to pancreatic carcinomas. Due to their location, they tend to become symptomatic at an earlier stage compared to pancreatic malignancies. This behaviour results in a higher resectability rate at diagnosis. From a pathological point of view they arise in a zone of transition between two different epithelia, and, according to their origin, may be divided into pancreatobiliary or intestinal type. This classification has a substantial impact on prognosis. In most cases, pancreaticoduodenectomy represents the treatment of choice when there is an overt or highly suspicious malignant behaviour. The rate of potentially curative resection is as high as 90% and in high-volume centres an acceptable rate of complications is reported. In selected situations less invasive approaches, such as ampullectomy, have been advocated, although there are some concerns mainly because of a higher recurrence rate associated with limited resections for invasive carcinomas. Importantly, these methods have the drawback of not including an appropriate lymphadenectomy, while nodal involvement has been shown to be frequently present also in apparently lowrisk carcinomas. Endoscopic ampullectomy is now the procedure of choice in case of low up to high-grade dysplasia providing a proper assessment of the T status by endoscopic ultrasound. In the present paper the evidence currently available is reviewed, with the aim of offering an updated framework for diagnosis and management of this specific type of disease.

Original languageEnglish
Pages (from-to)7970-7987
Number of pages18
JournalWorld Journal of Gastroenterology
Volume21
Issue number26
DOIs
Publication statusPublished - Jul 14 2015

Keywords

  • Ampulla of Vater
  • Ampullary neoplasm
  • Ampullectomy
  • Cancer of the ampulla of Vater
  • Lymphadenectomy
  • Pancreaticoduodenectomy
  • Prognosis
  • Recurrence

ASJC Scopus subject areas

  • Gastroenterology

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    Panzeri, F., Crippa, S., Castelli, P., Aleotti, F., Pucci, A., Partelli, S., Zamboni, G., & Falconi, M. (2015). Management of ampullary neoplasms: A tailored approach between endoscopy and surgery. World Journal of Gastroenterology, 21(26), 7970-7987. https://doi.org/10.3748/wjg.v21.i26.7970