A 34-year-old female underwent robotic pancreatoduodenectomy in June 2018. Recovery was uneventful and pathology disclosed poorly differentiated adenocarcinoma of the Ampulla of Vater T3bN1M0. She was trying to become pregnant of her first child when she received this diagnosis. MDT decided for adjuvant chemotherapy, but she decided to preserve her fertility by embryo cryopreservation. She then received 12 cycles of Folfirinox. She is well with no signs of disease 18 months after operation and fully recovered. The main question is when is the appropriate time to conceive? Should we wait 5 years? 2 years? 3 years? I did not find any answer in the current literature with this type of tumor.
This is a very tricky question. It is frequently seen that tumors can occur or reoccur when women are pregnant. My wife frequently sees these kinds of women in her hospital both as a gynecologic oncologist and obstetric specialist. There are no real good recommendations but based on the general prognosis of papilla cancers I would be very reluctant in recommending pregnancy to the patient.
Thank you Andreas. I was thinking about 5 years after the event. This is the time we wait for patient with cancer to be eligible to a liver transplantation but I will definitively consider your thought before any further advice to my patient.