Carcinoma of the Ampulla of Vater: Contributions of Imaging for Choosing Local Resection or Radical Surgery.

Abstract

Introduction: Ampullary carcinoma is a rare neoplasm of the gastrointestinal tract characterized by its heterogeneous biological behavior and potential for surgical cure. Choosing between local resection and radical surgery is a clinical challenge, where imaging plays a central role in preoperative staging and therapeutic planning. Objective: To analyze the available evidence on the contribution of imaging techniques in the preoperative evaluation of ampullary carcinoma and their role in selecting between local resection and radical surgery. Methodology: A systematic review was conducted following the PRISMA 2020 statement. The search was carried out in PubMed/MEDLINE, including studies published between 2020 and October 2025. Original studies and systematic reviews evaluating imaging modalities for staging, therapeutic selection, or prognostic prediction of ampullary carcinoma were included. Selection was performed by two independent reviewers, and synthesis was narrative due to methodological heterogeneity. Results: Six studies were included. Endoscopic ultrasound and intraductal ultrasonography showed high accuracy for local staging, although with limited ability to detect nodal metastases. Computed tomography and magnetic resonance imaging provided key information on extraluminal extension, tumor aggressiveness, and prognosis. Radiomic models improved the prediction of nodal involvement and recurrence. In selected patients, local resection was associated with lower morbidity, conditional on a strict imaging evaluation. Conclusion: Imaging is fundamental for therapeutic decision-making in ampullary carcinoma. An integrated multimodal approach allows for appropriate selection between local resection and radical surgery, optimizing oncological outcomes and minimizing morbidity.