title: Management of ampullary neoplasms: A tailored approach between endoscopy and surgery.
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 low-risk 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.
authors.affiliation: Francesca Panzeri, Department of Surgery, Ospedale "Mater Salutis", 37045 Legnago, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Panzeri
authors.affiliation: Francesca Panzeri, Department of Surgery, Ospedale "Mater Salutis", 37045 Legnago, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Crippa
authors.affiliation: Francesca Panzeri, Department of Surgery, Ospedale "Mater Salutis", 37045 Legnago, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Castelli
authors.affiliation: Francesca Panzeri, Department of Surgery, Ospedale "Mater Salutis", 37045 Legnago, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Aleotti
authors.affiliation: Francesca Panzeri, Department of Surgery, Ospedale "Mater Salutis", 37045 Legnago, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Pucci
authors.affiliation: Francesca Panzeri, Department of Surgery, Ospedale "Mater Salutis", 37045 Legnago, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Partelli
authors.affiliation: Francesca Panzeri, Department of Surgery, Ospedale "Mater Salutis", 37045 Legnago, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Zamboni
authors.affiliation: Francesca Panzeri, Department of Surgery, Ospedale "Mater Salutis", 37045 Legnago, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Falconi
mesh_terms: D000465:Algorithms; D014670:Ampulla of Vater / Q000473:pathology / Q000601:surgery*; D003137:Common Bile Duct Diseases / Q000453:epidemiology / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D019091:Critical Pathways; D016145:Endoscopy, Digestive System / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D008197:Lymph Node Excision; D009367:Neoplasm Staging; D016577:Pancreaticoduodenectomy / Q000009:adverse effects / Q000401:mortality; D011237:Predictive Value of Tests; D012307:Risk Factors; D016896:Treatment Outcome
keywords: Ampulla of Vater; Ampullary neoplasm; Ampullectomy; Cancer of the ampulla of Vater; Lymphadenectomy; Pancreaticoduodenectomy; Prognosis; Recurrence