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Invited Commentary
May 29, 2019

Adjuvant Therapy for Ampullary Cancer

Author Affiliations
  • 1Division of Hematology/Oncology, Department of Medicine, University of California, San Francisco
  • 2UCSF Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco
  • 3Division of General Surgery, Section of Surgical Oncology and Hepatopancreaticobiliary Surgery, Department of Surgery, University of California, San Francisco
JAMA Surg. 2019;154(8):715. doi:10.1001/jamasurg.2019.1171

For periampullary cancers, including adenocarcinoma of the pancreas, ampulla, bile duct, and duodenum, a curative-intent pancreaticoduodenectomy provides the only chance for long-term survival. Adjuvant systemic therapy has been conclusively shown to improve survival after surgery for pancreatic cancer,1 but there is far less convincing evidence regarding the benefit of adjuvant therapy for other periampullary cancers.2 This lack of evidence is because of several factors: the low incidence of nonpancreas periampullary cancers, difficulty determining their exact site of origin, and, for biliary tract cancers, the pooling together of hilar, intrahepatic and extrahepatic cholangiocarcinomas, and gallbladder carcinomas under a single study “umbrella.”3,4 Complicating matters further is that such patients also frequently develop clinically relevant postoperative pancreatic fistulas, hampering their ability to receive timely adjuvant therapy.

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