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Practice Guideline
. 2024 Sep;56(9):1452-1460.
doi: 10.1016/j.dld.2024.04.027. Epub 2024 Jun 6.

Ampullary tumors: French Intergroup Clinical Practice Guidelines for diagnosis, treatments and follow-up (TNCD, SNFGE, FFCD, UNICANCER, GERCOR, SFCD, SFED, ACHBT, AFC, SFRO, RENAPE, SNFCP, AFEF, SFP, SFR)

Vincent Hautefeuille  1 , Nicolas Williet  2 , Anthony Turpin  3 , Bertrand Napoleon  4 , Aurélien Dupré  5 , Florence Huguet  6 , Anne Laure Bignon  7 , Marine Camus  8 , Jean-Baptiste Chevaux  9 , Romain Coriat  10 , Jérôme Cros  11 , Julien Edeline  12 , Stéphane Koch  13 , Cindy Neuzillet  14 , Géraldine Perkins  15 , Jean Marc Regimbeau  16 , David Sefrioui  17 , Carole Vitellius  18 , Marie-Pierre Vullierme  19 , Olivier Bouché  20 , Sébastien Gaujoux  21 ; Thésaurus National de Cancérologie Digestive (TNCD); Société Nationale Française de Gastroentérologie (SNFGE); Fédération Francophone de Cancérologie Digestive (FFCD); Fédération Nationale des Centres de Lutte Contre le Cancer (UNICANCER); Groupe Coopérateur multidisciplinaire en Oncologie (GERCOR); Société Française de Chirurgie Digestive (SFCD); Société Française d'Endoscopie Digestive (SFED); Association de Chirurgie Hépato-Bilio-Pancréatique et Transplantation (ACHBT); Société́ Française de Pathologie (SFP); Société Française de Radiothérapie Oncologique (SFRO); Réseau National de Référence des Tumeurs Rares du Péritoine (RENAPE); Société Nationale Française de Colo-Proctologie (SNFCP); Association Française pour l’Étude du Foie (AFEF); Société Française de Radiologie (SFR)
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Free article
Practice Guideline

Ampullary tumors: French Intergroup Clinical Practice Guidelines for diagnosis, treatments and follow-up (TNCD, SNFGE, FFCD, UNICANCER, GERCOR, SFCD, SFED, ACHBT, AFC, SFRO, RENAPE, SNFCP, AFEF, SFP, SFR)

Vincent Hautefeuille et al. Dig Liver Dis. 2024 Sep.
Free article

Abstract

Background: Management of ampullary tumors (AT) is challenging because of a low level of scientific evidence. This document is a summary of the French intergroup guidelines regarding the management of AT, either adenoma (AA) or carcinoma (AC), published in July 2023, available on the website of the French Society of Gastroenterology (SNFGE) (www.tncd.org).

Methods: A collaborative work was conducted under the auspices of French medical, endoscopic, oncological and surgical societies involved in the management of AT. Recommendations are based on recent literature review and expert opinions and graded in three categories (A, B, C), according to quality of evidence.

Results: Accurate diagnosis of AT requires at least duodenoscopy and EUS. All patients should be discussed in multidisciplinary tumor board before treatment. Surveillance may only be proposed for small AA in familial adenomatous polyposis. For AA, endoscopic papillectomy is the preferred option only if R0 resection can be achieved. When not possible, surgical papillectomy should be considered. For AC beyond pT1a N0, pancreaticoduodenectomy is the procedure of choice. Adjuvant monochemotherapy (gemcitabine, 5FU) may be proposed. For aggressive tumors (pT3/T4, pN+, R1, poorly differentiated AC, pancreatobiliary differentiation) with high risk of recurrence, 6 months polychemotherapy (CAPOX/FOLFOX for the intestinal subtype and mFOLFIRINOX for the pancreatobiliary or the mixed subtype) may be a valid alternative. Clinical and radiological follow up is recommended for 5 years.

Conclusions: These guidelines help to homogenize and highlight unmet needs in the management of AA and AC. Each individual case should be discussed by a multidisciplinary team.

Keywords: Ampullary tumors; Chemotherapy; Endoscopy; French intergroup clinical practice guidelines; Prognosis; Surgery.

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Conflict of interest statement

Conflict of interest VH: AAA, Amgen, Esteve, Ipsen, Deciphera, Merck, Pierre Fabre, Servier AT: personal fees from Servier, Viatris, Incyte Bioscience, BMS, Merck and grants from AstraZeneca and MSD outside the submitted work MC: Medtronic, Boston Scientific, Cook Medical, AMBU CN: Honoraria / consulting: Amgen, AstraZeneca, Baxter, Bristol-Myers Squibb, Fresenius Kabi, Incyte Biosciences, Merck, MSD, Mundipharma, Novartis, Nutricia, OSE Immunotherapeutics, Pierre Fabre, Roche, Sanofi, Servier, Viatris. Research funding / clinical trials: AstraZeneca, Bristol-Myers Squibb, Fresenius Kabi, Nutricia, OSE Immunotherapeutics, Roche, Servier, Viatris. ALB declares consulting for Astra Zeneca , Servier, Ipsen and accomodations or congress registration support for Merck and Ipsen DS: Honoraria / consulting: Amgen, Bayer, Deciphera Pharmaceutical, Ipsen, Pierre fabre, Roche, Servier, Viatris, Travel accomodations: AstraZeneca, Ipsen, Novartis, Pfizer, Pierre Fabre, Roche, Sandoz, Servier GP: honoraria from Servier, Roche and Sanofi OB: honoraria from Amgen, Apmonia Therapeutics, Bayer, Deciphera, Merck KGaA, MSD, Pierre Fabre, Servier. SG: Mylan, IPSEN All other authors declare no conflict of interest related to this article.

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