Surgical ampullectomy: A comprehensive review

Table 1 Indications for surgical ampullectomy

Lesion type	Generally accepted indications	Uncertainties	Generally accepted contra-indications	Ref.
Adenoma	Lesion too large for EP, including those with HGD or Cis	Tumour size thresholds		[6,10,12,13,20-24,26,37-40,42,44,46,49,51,52]
	Failed EP, including recurrence or positive margins			[42,52]
		FAP patients		[53-55]
AAC	T1 or T2, unfit for PD	T1 or T2, fit for PD	T3 or T4, fit for PD	[6,21-24,30,39,41,43-46,49,51,58]
	Well-differentiated	Moderately-differentiated	Poorly-differentiated	[21,23,30,39,43,49,56,57,60]
			Nodal or distant metastases	[21,23,24,30,39,41,49]
		Requirement for lymphadenectomy		[39,57]
		Intraductal extension		[10,12,19,21,26,56]
Others	Sphincterotomy-associated biliary stricture			[70]
		Neuroendocrine tumours		[66,67]

AAC: Ampullary adenocarcinoma; FAP: Familial adenomatous polyposis; EP: Endoscopic papillectomy; HGD: High-grade dysplasia; PD: Pancreatoduodenectomy.