Preoperative biopsy for suspected adenocarcinoma of the pancreatic head; yield and complications

The aim: To analyze results of surgical treatment of patients with chronic pancreatitis (CP) and to assess the causes of pancreatic cancer after surgical treatment. Materials and methods: 137 patients had duodenum-preserving resections of the pancreas. Results: In the histological examination of the pancreas it was established that the growth of fibrous tissue was registered in patients with CP., which in 19 (13.8%) almost completely replaced the acinar tissue. In the long term after the operation from 6 months to 2 years in 8 patients (5.8%) pancreatic cancer was detected. Possible causes of tumor origin were analyzed, the value of preservation of ductal hypertension, which affects the state of the duct’s epithelium, was established. The most commonly used for treatment of chronic pancreatitis the Frey surgery removed pancreatic hypertension but in two patients during the operation an insufficient volume of the pancreatic head was reconstructed. In the case of the abandonment of a large array of fibrous tissue, local hypertension was retained in the region of the ductal structures of the head, which led to the transformation of the duct epithelium. An essential factor in the problem of the preservation of pancreatic hypertension were the stenosis of pancreatic intestinal anastomoses, they arose in the long term in 4 operated patients. With stenosis of anastomosis after duodenum-preserving resection both the hypertension factor and the regeneration factor could be realized, which under certain circumstances might be significant. Conclusion: After resection of the pancreas for CP cancer was diagnosed in 5.8% of patients. The main method of preventing the risk of cancer was performing the Frey surgery for CP eliminating pancreatic hypertension in the head region of the pancreas. Diagnosis of stenosis in the late period after resection of the pancreas was an important element in the prevention of recurrence of cancer since a timely reconstructive operation could improve the drainage of duct structures.

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POSSIBILITIES OF CT IN DETECTION OF PORTAL CAVERNOMA, DIFFERENTIAL DIAGNOSIS WITH ADENOCARCINOMA OF THE PANCREATIC HEAD

Russian Electronic Journal of Radiology ◽

10.21569/2222-7415-2020-10-4-277-283 ◽

2020 ◽

Vol 10 (4) ◽

pp. 277-283

Author(s):

T.N. Trofimova ◽

◽

M.M. Druzina ◽

M.Ya. Belikova ◽

◽

...

Keyword(s):

Differential Diagnosis ◽

Pancreatic Head ◽

Portal Cavernoma

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Lymphoepithelial cyst of the pancreatic head.

American Journal of Roentgenology ◽

10.2214/ajr.165.2.7618595 ◽

1995 ◽

Vol 165 (2) ◽

pp. 489-489 ◽

Cited By ~ 9

Author(s):

D S Katz ◽

G M Scatorchia ◽

A R Wojtowycz ◽

R J Botash

Keyword(s):

Pancreatic Head ◽

Lymphoepithelial Cyst

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Pancreas-Preserving Total Duodenectomy: A Systematic Review

Digestive Surgery ◽

10.1159/000515718 ◽

2021 ◽

pp. 1-12

Author(s):

Miguel Cantalejo-Díaz ◽

José Manuel Ramia-Ángel ◽

Ana Palomares-Cano ◽

Mario Serradilla-Martín

Keyword(s):

Systematic Review ◽

Postoperative Morbidity ◽

Operating Time ◽

Pancreatic Head ◽

Cochrane Library ◽

Morbidity Rate ◽

Intraoperative Bleeding ◽

Risks And Benefits ◽

Duodenal Lesions ◽

The Mean

Background: The management of the pancreas in patients with duodenal trauma or duodenal tumors remains a controversial issue. Pancreas-preserving total duodenectomy (PPTD) requires a meticulous surgical technique. The most common indication is familial duodenal adenomatous polyposis (FAP). The aims of this study are to carry out a systematic review of the literature on the indications for PPTD and to highlight the risks and benefits compared with other more aggressive procedures. Summary: A systematic literature review was performed following PRISMA recommendations of studies published in PubMed, Embase, and Cochrane library until May 2019. Thirty articles describing 211 patients were chosen. The mean age was 48 years. The surgical indication in 75% of patients was FAP. The mean operating time was 329 min and mean intraoperative bleeding 412 mL. Postoperative morbidity rate was 49.7% (76% Clavien-Dindo <IIIa), and mortality rate was 1.4%. The mean hospital stay was 22 days. Overall survival at 1–3–5 years was >97.8%. Key Messages: PPTD is indicated for patients with benign and premalignant duodenal lesions without involvement of the pancreatic head. It is a feasible procedure offering an alternative to other more aggressive procedures in selected patients. Mortality is below 1.5%.

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A simple nomogram for early postoperative risk prediction of clinically relevant pancreatic fistula after pancreatoduodenectomy

Langenbeck s Archives of Surgery ◽

10.1007/s00423-021-02184-y ◽

2021 ◽

Author(s):

K. C. Honselmann ◽

C. Antoine ◽

L. Frohneberg ◽

S. Deichmann ◽

L. Bolm ◽

...

Keyword(s):

Delayed Gastric Emptying ◽

Model Building ◽

Pancreatic Head ◽

Operation Time ◽

Early Postoperative Period ◽

Serum Lipase ◽

Internal Validation ◽

Model Method ◽

Postoperative Risk ◽

Life Threatening

Abstract Purpose Postoperative pancreatic fistulae (POPF) present a serious and life-threatening complication after pancreatic head resections (PD). Therefore, reliable risk stratification to identify those at risk is urgently needed. The aim of this study was to identify postoperative laboratory parameters for the prediction of POPF in the early postoperative period. Methods One hundred eighty-two patients who underwent PD from 2012 until 2017 were retrospectively analyzed. Multivariate logistic regression was performed using the GLM (general linear model) method for model building. Two nomograms were created based on the GLM models of postoperative day one and postoperative day one to five. A cohort of 48 patients operated between 2018 and 2019 served as internal validation. Results Clinically relevant pancreatic fistulae (CR-POPF) were present in 16% (n = 29) of patients. Patients with CR-POPF experienced significantly more insufficiencies of gastroenterostomies, delayed gastric emptying, and more extraluminal bleeding than patients without CR-POPF. Multivariate analysis revealed multiple postoperative predictive models, the best one including ASA, main pancreatic duct diameter, operation time, and serum lipase as well as leucocytes on day one. This model was able to predict CR-POPF with an accuracy of 90% and an AUC of 0.903. Two nomograms were created for easier use. Conclusion Clinically relevant fistula can be predicted using simple laboratory and clinical parameters. Not serum amylase, but serum lipase is an independent predictor of CR-POPF. Our simple nomograms may help in the identification of patients for early postoperative interventions.

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