Surgical treatment of ampullary cancer

Abstract

Ampullary cancer is classified as a biliary tract malignancy, predominantly affecting individuals over 50 years of age with a male predominance. Ampullary cancer accounts for 5-10% of biliary cancers and demonstrates a postoperative 5-year survival rate of 52.8%, which is higher compared to bile duct cancer (33.1%) and gallbladder cancer (41.6%). Familial adenomatous polyposis is an established risk factor for ampullary cancer, whereas no specific risk factors have been identified for sporadic cases. While local resection may be considered for ampullary adenomas, clinical challenges arise in differentiating carcinoma within adenoma, and assessing deep tissue invasion. Consequently, pancreaticoduodenectomy remains the standard procedure for patients with preoperative diagnosis of ampullary cancer (regardless of T-stage) and adenomas extending into pancreatic/biliary ducts. This review article systematically outlines the surgical management of ampullary cancer in alignment with the Clinical Practice Guidelines for Biliary Tract Cancers (4th Edition) and the General Rules for Clinical and Pathological Studies on Cancer of the Biliary Tract (7th Edition).