Incidence and clinical findings of benign, inflammatory disease in patients resected for presumed pancreatic head cancer

T. M. Van Gulik, J. W A J Reeders, A. Bosma, T. M. Moojen, N. J. Smits, J. H. Allema, E. A J Rauws, G. J A Offerhaus, H. Obertop, D. J. Gouma

Research output: Contribution to journalArticlepeer-review

Abstract

Background: The differentiation between cancer and benign disease in the pancreatic head is difficult. The aim of this study was to examine common features in a group of patients that had undergone pancreatoduodenectomy for a benign, inflammatory lesion misdiagnosed as pancreatic head cancer. Methods: Among 220 pancreatoduodenectomies performed on the suspicion of pancreatic head cancer, an inflammatory lesion in the pancreas or distal common bile duct was diagnosed in 14 patients (6%). Of these patients, all preoperative clinical information and radiologic images (ultrasound, endoscopic retrograde cholangio-pancreaticography [ERCP]) were critically reassessed. For each examination, the suspicion of cancer was scored on a 0/+/++ scale. Results: Clinical presentation (pain, weight loss, jaundice) raised a suspicion of cancer in 12 patients. On ultrasound, a tumor (mean size: 2.8 cm) was found in the pancreatic head in 13 patients; 12 of 14 ultrasound examinations raised a suspicion of cancer. ERCP showed a distal common bile duct stenosis (length: 1 to 4 cm), stenosis of the pancreatic duct (length: 1 to 5 cm), or a 'double duct' stenosis, suspicious for cancer in 13 evaluable patients. The overall index of suspicion was + in seven patients and ++ in seven patients, confirming the initial interpretation of preoperative data. Conclusion: When undertaking pancreatoduodenectomy for a suspicious lesion in the pancreatic head, it is necessary to expect at least a 5% chance of resecting a benign, inflammatory lesion masquerading as cancer.

Original languageEnglish (US)
Pages (from-to)417-423
Number of pages7
JournalGastrointestinal Endoscopy
Volume46
Issue number5
DOIs
StatePublished - 1997
Externally publishedYes

ASJC Scopus subject areas

  • Gastroenterology

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