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Pancreatic head cancer in patients with chronicpancreatitis

Hepatobiliary & Pancreatic Diseases International 2014年第2期13卷 192-197页

作者： Aude Merdrignac Laurent Sulpice Michel Rayar Tanguy Rohou Emmanuel Quéhen ayman zamreek Karim Boudjema Bernard Meunier Service de Chirurgie Hépatobiliaire et Digestive H pital PontchaillouCentre Hospitalier Universitaire INSERM UMR991 FoieMétabolismes et Cancer Service d'Imagerie Médicale H pital Pontchaillou

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 definitive pathological ***: 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 definitive pathological finding was retrospectively confronted with the decision made at an MM, and patients were classified 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 findings in order to identify predictive factors of malignant ***: During the study period, five of 18 (group 1) patients with CP had PD were histologically confirmed to have PA, and the other 13 (group 2) did not have PA. The median age was52.5 ±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 (ClavienDindo classification ≥3). There was no statistical difference in clinical and biological parameters between the two groups. The rereading of imaging data could not detect efficiently all patients with ***: Our results confirmed the difficulty 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.

关键词： chronic pancreatitis adenocarcinoma pancreaticoduodenectomy

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