From endoscopic resection to pancreatoduodenectomy: a narrative review of treatment modalities for the tumors of the ampulla of Vater

Abstract

Background and Objective: Tumors of the ampulla of Vater are a rare set of lesions that arise at the confluence of the common bile duct (CBD) and the pancreatic duct. They can be benign or malignant, often not easy to discriminate before treatment. Malignant tumors have low chances of survival (overall 5-year survival between 0% and 60%) and surgery is still the only curative option. Prognostic factors are being investigated to tailor therapeutic approach and improve outcomes. Due to their location in a complex anatomical region, all treatment options are challenging and associated with relevant morbidity. In this review we discuss different excisional techniques for the treatment of ampullary tumors (AT).Methods: A review of medical databases (PubMed and Google Scholar) was conducted selecting most relevant articles in English language without a specific timeframe. After first selection, most relevant citations were identified through snowballing.Key Content and Findings: Pancreatoduodenectomy (PD) is the gold standard in malignant tumors, achieving the most radical treatment, at the price of worse perioperative morbidity/mortality and quality of life. Trans-duodenal ampullectomy (TDA) was developed before endoscopic resection (ER) and maintains a role only in selected patients. ER is now the first choice for benign lesions and expanding towards early stages malignant AT.Conclusions: Pancreatodudenectomy remains the best option for the radical excision of malignant AT, recently being offered also via minimally invasive approach. However, in early-stage malignant tumors, ER is gaining importance with foreseeable further expansion. Transduodenal ampullectomy still has a role in selected patients, such as unfit for PD when ER is not possible mainly due to anatomical abnormalities.

Machine learning models for predicting survival in patients with ampullary adenocarcinoma

“… 4 , 12 , 13 High-quality evidence from clinical trials of AAC is currently inadequate, and relevant data are mostly collected from subgroup analyses of pancreaticobiliary malignancies or retrospective analyses. 14 Specific treatment decisions and prognoses of AAC are under discussion including the construction of the American Joint Committee on Cancer (AJCC) TNM staging system. 10 Knowledge of the prognostic factors associated with different survival outcomes among patients with AAC is important for survival predictions and nursing planning.…”

“…Different centers have reported a wide range of 5-year overall survival (OS) rates after AAC resection of 32-69.1%, with median survival time of 28-70 months, while the 10-year OS rate ranged from 26% to 48% 4,12,13 . High-quality evidence from clinical trials of AAC is currently inadequate, and relevant data are mostly collected from subgroup analyses of pancreaticobiliary malignancies or retrospective analyses 14 . Specific treatment decisions and prognoses of AAC are under discussion including the construction of the American Joint Committee on Cancer (AJCC) TNM staging system 10 .…”