Controversies in the diagnosis and treatment of periampullary tumours

Elsevier

Available online 14 September 2022, 101853

Surgical OncologyHighlights•

Tumours located within 2 cm of the greater duodenal papilla, have been usually described as periampullary neoplasms.

The current classification of the periampullary carcinomas is based on the anatomical location and the epithelium the tumours is originate from. This classification is subjective and prone to diagnostic variability (between pathologists), and it can significantly influence treatment choice.

Although the tumours of the periampullary area are increasingly diagnosed, TNM staging remains a significant challenge due to the lack of familiarity with this region.

Surgical treatment is the only chance for cure. Pancreatoduodenectomy is the procedure of choice.

Indications for adjuvant chemotherapy remain controversial. All decisions regarding adjuvant therapy in periampullary cancer patients should be discussed in detail by a multidisciplinary team.

The clinical trials are lacking due to an artificially extracted, small group of patients. Currently, there is only one ongoing, prospective, single-arm observational study focusing on systemic treatment named CHAMP (Chemotherapy, Host response And Molecular dynamics in Periampullary cancer).

Since the value of a multimodality regimen remains poorly defined, prospective studies are recommended to evaluate the effect of subtype-stratified adjuvant therapy.

Hopefully, molecular characteristics of individual periampullary cancers may allow a personalised therapeutic approach to improve survival.

Abstract

Most tumours in the head of the pancreas are adenocarcinomas of the exocrine pancreas. However, carcinomas located in the head of the pancreas may originate from the papilla of Vater, the distal part of the common bile duct, or the duodenum. Tumours of that region, within 2 cm of the greater duodenal papilla, have been usually described as periampullary neoplasms. Adenocarcinomas separated from the major duodenal papilla and located in the major pancreatic duct, common bile duct, or duodenum are identified as ductal pancreatic carcinomas, distal bile duct cholangiocarcinomas or duodenal carcinomas. Surgical treatment is the only chance for cure. Pancreatoduodenectomy is the procedure of choice. Regional lymphadenectomy and removal of at least 16 lymph nodes are necessary for optimal long-term outcomes. Indications for adjuvant chemotherapy remain controversial. This review evaluates the available data on the pathological assessment of periampullary tumours and discusses the controversies of therapeutic management, emphasising adjuvant treatment.

Keywords

Periampullary carcinoma

Ampullary tumours

Adjuvant chemotherapy

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© 2022 Published by Elsevier Ltd.

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