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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Ko AH, Nakakura EK. Adjuvant Therapy for Ampullary Cancer. JAMA Surg. Published online May 29, 2019. doi:10.1001/jamasurg.2019.1171
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