Pancreatic cancer in chronic pancreatitis – the diagnostic and therapeutic dilemma; an overview of cases
Authors:
M. Loveček 1; P. Skalický 2; J. Tesaříková 1; O. Urban 3; P. Falt 3; D. Kurfúrstová 4; D. Klos 2
Authors‘ workplace:
I. chirurgická klinika Fakultní nemocnice Olomouc
1; I. chirurgická klinika Lékařské fakulty Univerzity Palackého Olomouc
2; II. interní gastroenterologická – geriatrická klinika Fakultní nemocnice Olomouc
3; Ústav klinické a molekulární patologie Lékařské fakulty Univerzity Palackého Olomouc
4
Published in:
Rozhl. Chir., 2022, roč. 101, č. 11, s. 549-550.
Category:
Case Report
doi:
https://doi.org/10.33699/PIS.2022.101.11.549–556
Overview
Introduction: Any mass in chronic pancreatitis (CP) is a difficult diagnostic and therapeutic problem. The aim of the study is a) to use our own group to determine the actual incidence of non-malignant masses in CP where any mass is highly suspected of being malignant; and b) to determine the actual incidence of malignant tumors in CP.
Methods: We present a retrospective analysis of our group of patients operated in 2015–2019 for CP, a mass in CP and suspected malignancy in the mass in CP. Additionally, we present difficult cases in terms of preoperative diagnosis.
Results: Thirty-three of 340 (9.7%) pancreatic resection were done due to any form of chronic pancreatitis in 2015–2019. A mass in the pancreatic head was present in 16 (48%) patients; of these, pancreatic ductal adenocarcinoma (PDAC) was suspected in 10 (62%) patients based on EUS, CT or PETCT, and also based on positive tissue diagnosis using EUS-FNA in 6 cases. Bypass or Frey procedure were done in 59 patients (HJA, PJA, Frey). Preoperative tissue sampling was done in 8 (13%) patients and malignancy was suspected in 25%. Intraoperatively, malignancy was confirmed only in one patient assessed as non-malignant in the preoperative period. The clinical course in 3 other patients undergoing HJA, although tumor-free at the time of the surgery, indicated PDAC in CP.
Conclusion: The ability to detect malignant cells in a mass in CP remains poor even using all of the available sophisticated methods and the success depends on many variable factors. The rate of “unnecessary” right-sided resections of a mass in CP reached 48% in our patient group, while the rate of resections which should have been performed instead of bypass procedures was 7%. A certain percentage of the so-called excessive pancreatic resections, as well as the failure to perform a resection due to an undetected/unrecognized pancreatic tumor in CP should continue to be expected.
Keywords:
Pancreatic cancer – Pancreas – chronic pancreatitis – case reports – non-malignant mass
Sources
1. Lowenfels AB, Maisonneuve P, Cavallini G, et al. Prognosis of chronic pancreatitis: an international multicenter study. International Pancreatitis Study Group. Am J Gastroenterol. 1994;89(9):1467–1471.
2. Lowenfels AB, Sullivan T, Fiorianti J, et al. The epidemiology and impact of pancreatic diseases in the United States. Curr Gastroenterol Rep. 2005;7(2):90–95. doi:10.1007/s11894-005-0045-6.
3. Howes N, Lerch MM, Greenhalf W, et al. Clinical and genetic characteristics of hereditary pancreatitis in Europe. Clin Gastroenterol Hepatol. 2004;2(3):252–261. doi:10.1016/s1542-3565(04)00013-8.
4. Raimondi S, Lowenfels AB, Morselli-Labate AM, et al. Pancreatic cancer in chronic pancreatitis; aetiology, incidence, and early detection. Best Pract Res Clin Gastroenterol. 2010;24(3):349–358. doi:10.1016/j.bpg.2010.02.007.
5. Levy P, Milan C, Pignon JP, et al. Mortality factors associated with chronic pancreatitis. Unidimensional and multidimensional analysis of a medical-surgical series of 240 patients. Gastroenterology 1989;96(4):1165–1172.
6. Seicean A, Tantau M, Grigorescu M, et al. Mortality risk factors in chronic pancreatitis. J Gastrointestin Liver Dis. 2006;15(1):21–26.
7. Hoffmeister A, Mayerle J, Beglinger C, et al. English language version of the S3-consensus guidelines on chronic pancreatitis: Definition, aetiology, diagnostic examinations, medical, endoscopic and surgical management of chronic pancreatitis. Z Gastroenterol. 2015;53(12):1447– 1495. doi:10.1055/s-0041-107379.
8. www.cancer.net. 9. www.uzis.cz.
10. Burris HA 3rd, Moore MJ, Andersen J, et al. Improvements in survival and clinical benefit with gemcitabine as first-line therapy for patients with advanced pancreas cancer: a randomized trial. J Clin Oncol. 1997;15(6):2403–2413. doi:10.1200/JCO.1997.15.6.2403.
11. Dítě P, Novotný I, Přecechtělová M, et al. Incidence pankreatického karcinomu u osob s chronickou pankreatitidou. Vnitř Lék. 2009;55(1):18–21.
12. Dhar P, Kalghatgi S, Saraf V. Pancreatic cancer in chronic pancreatitis. Ind J Surg Onc. 2015;6(1):57–62. doi:10.1007/ s13193-014-0373-9.
13. Will U, Mueller A, Topalidis T, et al. Value of endoscopic ultrasonography-guided fine needle aspiration (FNA) in the diagnosis of neoplastic tumor(-like) pancreatic lesions in daily clinical practice. Ultraschall Med. 2010;31(2):169–174. doi:10.1055/s-0028-1109491.
14. Fritscher-Ravens A, Brand L, Knofel WT, et al. Comparison of endoscopic ultrasound- guided fine needle aspiration for focal pancreatic lesions in patients with normal parenchyma and chronic pancreatitis. Am J Gastroenterol. 2002;97(11):2768–2775. doi:10.1111/j.1572-0241.2002.07020.x.
15. Kim JK, Altun E, Elias J, et al. Focal pancreatic mass: distinction of pancreatic cancer from chronic pancreatitis using gadolinium- enhanced 3D-gradient-echo MRI. J Magn Reson Imaging 2007;26(2):313– 322. doi:10.1002/jmri.21010.
16. Li X, Gao P, Wang Y, et al. Blood derived microRNAs for pancreatic cancer diagnosis: a narrative review and meta-analysis. Front Physiol. 2018;9:685. doi:10.3389/ fphys.2018.00685.
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Surgery Orthopaedics Trauma surgeryArticle was published in
Perspectives in Surgery
2022 Issue 11
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