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).

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.
Competing Interests: 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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