Pancreatic head cancer in patients with chronic pancreatitis

摘要

BACKGROUND: Chronic pancreatitis (CP) is a risk factor of pancreatic adenocarcinoma (PA). The discovery of a pancreatic head  lesion  in  CP  frequently  leads  to  a  pancreaticoduo­ denectomy (PD) which preceded by a multidisciplinary meeting (MM). The aim of this study was to evaluate the relevance between this indication of PD and the deifnitive pathological results. METHODS: Between 2000 and 2010, all patients with CP who underwent PD for suspicion of PA without any histological proof were retrospectively analyzed. The operative decision has always been made at an MM. The deifnitive pathological ifnding was retrospectively confronted with the decision made at an MM, and patients were classiifed in two groups according to this concordance (group 1) or not (group 2). Clinical and biological parameters were analyzed, preoperative imaging were reread, and confronted to pathological ifndings in order to identify predictive factors of malignant degeneration. RESULTS: During the study period, ifve of 18 (group 1) patients with CP had PD were histologically conifrmed to have PA, and the other 13 (group 2) did not have PA. The median age was 52.5 ±8.2 years (gender ratio 3.5). The main symptoms were pain (94.4%) and weight loss (72.2%). There was no patient's death. Six (33.3%) patients had a major complication (Clavien­ Dindo classiifcation ≥3). There was no statistical difference in clinical and biological parameters between the two groups. The rereading of imaging data could not detect efifciently all patients with PA. CONCLUSIONS: Our  results  conifrmed  the  dififculty  in detecting malignant transformation in patients with CP before surgery and therefore an elevated rate of unnecessary PD was found. A uniform imaging protocol is necessary to avoid PD as a less invasive treatment could be proposed.