Pancreatic head excavation for tissue diagnosis may reduce unnecessary pancreaticoduodenectomies in the setting of chronic pancreatitis

Fancellu, Alessandro; Ginesu, Giorgio Carlo; Feo, Claudio F.; Cossu, Maria Laura; Puledda, Marco; Pinna, Antonio; Porcu, Alberto

doi:10.1016/s1499-3872(17)60015-8

Cited by 5 publications

(5 citation statements)

References 39 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Two reports based on the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) and National Inpatient Sample demonstrated a significant increase in overall morbidity in patients with vascular tumor involvement [ 63 , 64 ]. In the present meta-analysis, we found that rates of pancreatic fistula, which remains one of the most dreaded complication following PD [ 65 , 66 , 67 ], were less frequent in the PD+VR group. This finding has also been reported by other authors.…”

Section: Discussionmentioning

confidence: 62%

The Impact on Survival and Morbidity of Portal–Mesenteric Resection During Pancreaticoduodenectomy for Pancreatic Head Adenocarcinoma: A Systematic Review and Meta-Analysis of Comparative Studies

Fancellu

Petrucciani

Porcu

et al. 2020

Cancers

Self Cite

View full text Add to dashboard Cite

Background: The literature is conflicting regarding oncological outcome and morbidity associated to portal–mesenteric resection during pancreaticoduodenectomy (PD) in patients with pancreatic head adenocarcinoma (PHAC). Methods: A meta-analysis of studies comparing PD plus venous resection (PD+VR) and standard PD exclusively in patients with adenocarcinoma of the pancreatic head was conducted. Results: Twenty-three cohort studies were identified, which included 6037 patients, of which 28.6% underwent PD+VR and 71.4% underwent standard PD. Patients who received PD+VR had lower 1-year overall survival (OS) (odds radio OR 0.79, 95% CI 0.67–0.92, p = 0.003), 3-year OS (OR 0.72, 95% CI 0.59–0.87, p = 0.0006), and 5-year OS (OR 0.57, 95% CI 0.39–0.83, p = 0.003). Patients in the PD+VR group were more likely to have a larger tumor size (MD 3.87, 95% CI 1.75 to 5.99, p = 0.0003), positive lymph nodes (OR 1.24, 95% CI 1.06–1.45, p = 0.007), and R1 resection (OR 1.74, 95% CI 1.37–2.20, p < 0.0001). Thirty-day mortality was higher in the PD+VR group (OR 1.93, 95% CI 1.28–2.91, p = 0.002), while no differences between groups were observed in rates of total complications (OR 1.07, 95% CI, 0.81–1.41, p = 0.65). Conclusions: Although PD+VR has significantly increased the resection rate in patients with PHAC, it has inferior survival outcomes and higher 30-day mortality when compared with standard PD, whereas postoperative morbidity rates are similar. Further research is needed to evaluate the role of PD+VR in the context of multimodality treatment of PHAC.

show abstract

Section: Discussionmentioning

confidence: 62%

The Impact on Survival and Morbidity of Portal–Mesenteric Resection During Pancreaticoduodenectomy for Pancreatic Head Adenocarcinoma: A Systematic Review and Meta-Analysis of Comparative Studies

Fancellu

Petrucciani

Porcu

et al. 2020

Cancers

Self Cite

View full text Add to dashboard Cite

show abstract

“…On oncological grounds, such situations violate the oncological principles and may prove fatal in the outcomes. However, the study population in both these studies is small (15 with Fancellu et al [78] and 3 with Mahesh et al [69]). …”

Section: Intraoperative Evaluationmentioning

confidence: 99%

“…Wedge biopsy, though under vision, often runs the risk of superficial biopsy because of the fear of a pancreatic ductal injury [77]. In a study by Fancellu et al [78], complete excavation of pancreatic head in suspected patients with head mass can provide larger pancreatic tissue for frozen analysis and was shown to increase accuracy in identifying malignancy.…”

Section: Intraoperative Evaluationmentioning

confidence: 99%

“…Fancellu et al [78] did pancreatic head excavation routinely for pancreatic head mass with suspicion of malignancy, and pancreaticoduodenectomy was offered to patients with malignancy on frozen section. Such patients had similar outcomes with those who underwent pancreaticoduodenectomy for clinico-radiologically suspected PDAC with CP.…”

Section: Intraoperative Evaluationmentioning

confidence: 99%

See 1 more Smart Citation

Diagnosis and Management of Pancreatic Adenocarcinoma in the Background of Chronic Pancreatitis: Core Issues

Narkhede

Desai

Prasad

et al. 2019

Dig Dis

View full text Add to dashboard Cite

Background: The incidence of pancreatic adenocarcinoma (PDAC) in patients with chronic pancreatitis (CP) is as high as 5%. It is a commonly encountered diagnostic challenge in patients with CP on long-term follow-up. Summary: This review consolidates the existing literature on assessment of PDAC in background of CP, its evaluation through the available investigations, surgical management, and prognostication. Recent change in symptomatology of an otherwise stable CP should raise a suspicion of malignancy. Endoscopic ultrasound (EUS) is more specific and sensitive in establishing the diagnosis of PDAC compared to cross-sectional imaging (computed tomography/magnetic resonance imaging). Intraoperative assessment with careful palpation coupled with careful clinical judgment helps in differentiating between an inflammatory mass and pancreatic cancer. Confirmation can be obtained with either preoperative EUS-guided fine needle cytology/core biopsy or intraoperative core biopsy under ultrasound guidance. However, despite complete evaluation with above options, 1–6% patients often show malignancy on final histopathological examination. Key Messages: Diagnosis of PDAC in CP needs a high index of suspicion. Cross-sectional imaging has poor negative predictive value. CA 19-9 with MUC5AC combination may become an ideal investigation. EUS with core biopsy/frozen section has a good sensitivity and specificity and low false negative results. Complete radical resection should be the aim to get long-term survival.

show abstract

“…While being performed under vision, wedge biopsy faces the risk of only collecting a superficial sample due to concern over damaging the pancreatic duct. Complete excavation of the pancreatic head in patients with suspected head masses can produce more pancreatic tissue for frozen sections, increasing diagnostic assurance in ruling out malignancy, as demonstrated by Fancellu et al [56]. According to recent studies, the accuracy of frozen section and histological interpretation has grown from 65 to 75 percent in the 1980s to above 90% [57].…”

Section: Intraoperative Evaluationmentioning

confidence: 99%

Approach to Pancreatic Head Mass in the Background of Chronic Pancreatitis

Harindranath

Giri

2023

Diagnostics

View full text Add to dashboard Cite

Chronic pancreatitis (CP) is a known risk factor for pancreatic cancer. CP may present with an inflammatory mass, and differentiation from pancreatic cancer is often difficult. Clinical suspicion of malignancy dictates a need for further evaluation for underlying pancreatic cancer. Imaging modalities remain the mainstay of evaluation for a mass in background CP; however, they have their shortcomings. Endoscopic ultrasound (EUS) has become the go-to investigation. Adjunct modalities such as contrast-harmonic EUS and EUS elastography, as well as EUS-guided sampling using newer-generation needles are useful in differentiating inflammatory from malignant masses in the pancreas. Paraduodenal pancreatitis and autoimmune pancreatitis often masquerade as pancreatic cancer. In this narrative review, we discuss the various modalities used to differentiate inflammatory from malignant masses of the pancreas.

show abstract

Pancreatic head excavation for tissue diagnosis may reduce unnecessary pancreaticoduodenectomies in the setting of chronic pancreatitis

Cited by 5 publications

References 39 publications

The Impact on Survival and Morbidity of Portal–Mesenteric Resection During Pancreaticoduodenectomy for Pancreatic Head Adenocarcinoma: A Systematic Review and Meta-Analysis of Comparative Studies

The Impact on Survival and Morbidity of Portal–Mesenteric Resection During Pancreaticoduodenectomy for Pancreatic Head Adenocarcinoma: A Systematic Review and Meta-Analysis of Comparative Studies

Diagnosis and Management of Pancreatic Adenocarcinoma in the Background of Chronic Pancreatitis: Core Issues

Approach to Pancreatic Head Mass in the Background of Chronic Pancreatitis

Contact Info

Product

Resources

About