Abstract
Ampullary adenocarcinoma is an uncommon neoplasm that most often requires pancreatoduodenectomy, has a less than optimal cure rate, and is a cancer for which the impact of multidisciplinary care remains unclear. Although often believed to have a better prognosis than pancreatic cancer, ampullary cancer remains a highly lethal disease. Given its rarity and the typical lack of surrounding vessel invasion, a surgery-first approach has most commonly been used in treatment sequencing. The literature has yielded conflicting results regarding the use of adjuvant therapy. Neoadjuvant therapy has received little attention but offers promise with regard to pathologic downstaging, particularly when chemotherapy is combined with radiation. Genetic evaluation may help guide future therapies, and multi-institutional trials are needed to develop optimal treatment sequencing and directed at the 2 specific histologic subtypes.
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