Therapeutic strategies and outcomes in the management of ampullary tumours: meta-analysis.

Anouk J de Wilde, Jan Faes, Karlijn E P E Hermans, Marc G Besselink, Jeska A Fritzsche, Matthias van Haele, Jan-Werner Poley, Rogier P Voermans, Judith De Vos-Geelen, Steven W M Olde Damink, Stefan A W Bouwense

Journal: BJS open 2026;10(4):

PMID: 42647826

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Abstract

BACKGROUND

Ampullary tumours are rare but present important clinical challenges. This meta-analysis aims to evaluate the outcomes of endoscopic resection (ER), transduodenal ampullectomy (TDA) and pancreatoduodenectomy (PD) for both benign and malignant ampullary tumours.

METHODS

A comprehensive search was performed up to 15 December 2025. Studies were included if they reported short-term outcomes including complete resection rate, recurrence, or complications of ampullary tumours after ER, TDA, or PD. Statistical analyses were performed using both random-effects and fixed-effects models to calculate pooled means. Publication bias was evaluated using funnel plots and Egger's test, and risk of bias was assessed using ROBINS-I V2.

RESULTS

A total of 80 studies were included. For complete resection rate, ER showed high heterogeneity (29%-100%), TDA showed a pooled rate of 90% for benign and early-stage tumours and 66% for malignant tumours, whereas PD showed 99% and 97%, respectively. ER and TDA showed both a pooled recurrence rate of 12% for benign and early-stage tumours, whereas PD showed 6%. For recurrence of malignant tumours, TDA showed high heterogeneity (48%-90%) whereas PD had a pooled rate of 16%. For complications, ER and PD exhibited high heterogeneity (9%-95% and 27%-98%, respectively), whereas TDA had a pooled rate of 32%.

CONCLUSION

PD provides the best outcomes in terms of complete resection and recurrence, despite higher morbidity. ER is a viable option for benign tumours, offering lower morbidity and manageable recurrence rates. Further prospective research is needed to optimize preoperative diagnostics to distinguish benign tumours from malignant tumours accurately to select the appropriate treatment.

Address: Department of Surgery and School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, the Netherlands.; Department of Surgery, Maastricht University Medical Centre+, Maastricht, the Netherlands.; Department of Surgery, Maastricht University Medical Centre+, Maastricht, the Netherlands.; Department of Internal Medicine, Division of Medical Oncology, GROW-Research Institute for Oncology & Reproduction, Maastricht University Medical Centre+, Maastricht, the Netherlands.; Amsterdam UMC, location University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands.; Cancer Centre Amsterdam, Amsterdam, the Netherlands.; Cancer Centre Amsterdam, Amsterdam, the Netherlands.; Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.; Department of Pathology, Maastricht University Medical Centre+, Maastricht, the Netherlands.; Department of Gastroenterology, Maastricht University Medical Centre+, Maastricht, the Netherlands.; Department of Surgery and School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, the Netherlands.; Department of Surgery, Maastricht University Medical Centre+, Maastricht, the Netherlands.; Department of General, Visceral, Vascular and Transplantation Surgery, University Hospital Essen, Essen, Germany.

DOI: 10.1093/bjsopen/zrag115

MeSH Terms: Humans, Ampulla of Vater, Common Bile Duct Neoplasms, Pancreaticoduodenectomy, Treatment Outcome, Neoplasm Recurrence, Local, Postoperative Complications