Periampullary Malignancies (Without Pancreatic Cancer)
Statement 8 proposed to manage distal bile duct cancer as equivalent to pancreatic cancer. However, the lack of consensus (71%) implies that surgery might have slightly less priority in comparison to pancreatic cancer since 23% of respondents disagreed on the other hand. The SSO stated that extrahepatic bile duct cancer and ampullary and duodenal adenocarcinomas should be operated as soon as feasible, regardless of the presence of symptoms.11 However, a high disagreement rate (40%) was reached on statement 15 for postponing surgery or giving neoadjuvant chemotherapy for duodenal and ampullary cancers in absence of life threatening risks (ie, bleeding, bowel obstruction). Since evidence is limited about the efficacy of neoadjuvant chemotherapy for these cancers so far and could not be deemed to stable diseases,11 many physicians might thought these should be resected as indicated.