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Invited Commentary
January 2017

Biology Trumps Anatomic Location in Periampullary Cancers

Author Affiliations
  • 1Division of Surgical Oncology, Department of Surgery, UC Davis Medical Center, University of California, Sacramento
JAMA Surg. 2017;152(1):89. doi:10.1001/jamasurg.2016.3482

It has long been observed that survival after surgical resection of periampullary invasive carcinoma varies widely with traditional subtyping based on the presumed anatomic location from which the tumor originated. Descriptive information from the pathologist’s report is then used for estimation of prognosis and selection for the administration of any adjuvant therapy. Yet, the traditional methods of pathologic description of resected periampullary neoplasms relied on histologic interpretation of the specific site of tumor origin, namely, the ampulla of Vater, distal common bile duct, duodenum, or pancreas. However, pathologists may have a difficult time because many of these carcinomas will invade adjacent tissues: is the ampullary cancer invading the pancreas or the adjacent tissue? Discrepancies in surgical pathology reports across all organ sites can be as high as 40%,1 raising concerns as to whether we are accurately subtyping periampullary neoplasms based on visual interpretation of histologic structure.

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