Pancreaticoduodenectomy for suspected but unproven malignancy

Jon S Thompson, Kenric M. Murayama, James A. Edney, Layton F. Rikkers

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Abstract

background: Pancreaticoduodenectomy is an accepted surgical option for certain benign conditions and biopsy proven cancer. Whether this procedure should be performed when malignancy of the pancreas and periampullary region is suspected but not confirmed represents a fairly common intraoperative dilemma. patients and methods: Sixty-seven patients who had undergone pancreaticoduodenectomy during a 15-year period were evaluated retrospectively. results: The indications for resection were symptomatic benign conditions (n = 10, 15%), proven pancreatic or periampullary cancer (n = 37, 55%), and suspected but unproven malignancy (n = 20, 30%). The patients with suspected malignancy ranged in age from 27 to 73 years. Common findings in this group were abdominal pain (75%), jaundice (70%), weight loss (65%), and alcohol use (45%). There were 14 pancreatic and 6 ampullary masses. Biopsies obtained preoperatively (n = 15) and intraoperatively (n = 11) were nonconfirmatory. Postoperatively 9 patients (45%) were found to have tumors, including 6 pancreatic adenocarcinoma, 2 duodenal adenocarcinoma, and 1 islet cell tumor. Six of the 8 adenocarcinomas (75%) were stage I. Seven patients were alive 11 to 108 months later. The most common benign diagnosis was pancreatitis. There were 8 complications and 1 death. conclusions: Pancreaticoduodenectomy performed based on suspicion alone frequently reveals malignancy. Immediate and long-term outcomes are acceptable. These findings justify a continued aggressive approach to suspected pancreatic and periampullary malignancy.

Original languageEnglish (US)
Pages (from-to)571-575
Number of pages5
JournalThe American Journal of Surgery
Volume168
Issue number6
DOIs
StatePublished - Jan 1 1994

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Pancreaticoduodenectomy
Neoplasms
Adenocarcinoma
Islet Cell Adenoma
Biopsy
Jaundice
Pancreatitis
Abdominal Pain
Weight Loss
Pancreas
Alcohols

ASJC Scopus subject areas

  • Surgery

Cite this

Pancreaticoduodenectomy for suspected but unproven malignancy. / Thompson, Jon S; Murayama, Kenric M.; Edney, James A.; Rikkers, Layton F.

In: The American Journal of Surgery, Vol. 168, No. 6, 01.01.1994, p. 571-575.

Research output: Contribution to journalArticle

Thompson, Jon S ; Murayama, Kenric M. ; Edney, James A. ; Rikkers, Layton F. / Pancreaticoduodenectomy for suspected but unproven malignancy. In: The American Journal of Surgery. 1994 ; Vol. 168, No. 6. pp. 571-575.
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abstract = "background: Pancreaticoduodenectomy is an accepted surgical option for certain benign conditions and biopsy proven cancer. Whether this procedure should be performed when malignancy of the pancreas and periampullary region is suspected but not confirmed represents a fairly common intraoperative dilemma. patients and methods: Sixty-seven patients who had undergone pancreaticoduodenectomy during a 15-year period were evaluated retrospectively. results: The indications for resection were symptomatic benign conditions (n = 10, 15{\%}), proven pancreatic or periampullary cancer (n = 37, 55{\%}), and suspected but unproven malignancy (n = 20, 30{\%}). The patients with suspected malignancy ranged in age from 27 to 73 years. Common findings in this group were abdominal pain (75{\%}), jaundice (70{\%}), weight loss (65{\%}), and alcohol use (45{\%}). There were 14 pancreatic and 6 ampullary masses. Biopsies obtained preoperatively (n = 15) and intraoperatively (n = 11) were nonconfirmatory. Postoperatively 9 patients (45{\%}) were found to have tumors, including 6 pancreatic adenocarcinoma, 2 duodenal adenocarcinoma, and 1 islet cell tumor. Six of the 8 adenocarcinomas (75{\%}) were stage I. Seven patients were alive 11 to 108 months later. The most common benign diagnosis was pancreatitis. There were 8 complications and 1 death. conclusions: Pancreaticoduodenectomy performed based on suspicion alone frequently reveals malignancy. Immediate and long-term outcomes are acceptable. These findings justify a continued aggressive approach to suspected pancreatic and periampullary malignancy.",
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