Pancreaticoduodenectomies in patients without periampullary neoplasms: lesions that masquerade as cancer.
BACKGROUND
Most pancreaticoduodenectomies (PDs) are performed to treat periampullary malignancies (PMs). Final pathologic analysis on these specimens does not always contain PMs. Our aim was to classify diseases that preoperatively mimic PMs.


METHODS
A prospective database of PDs performed at a single institution was reviewed. Clinicopathologic data on patients without PM on pathologic review with preoperative suspicion of PM were studied.


RESULTS
Of the 461 PDs performed at our institution, 45 (10%) had no PM; of these cases, 35 (78%) were performed for a clinical suspicion of malignancy. The final pathologic review showed chronic pancreatitis (CP) in 23 (66%) patients, biliary tract disease in 10 (28%) patients, duodenal ulcer in 1 (3%) patient, and distal common bile duct stricture with localized pancreatic fibrosis in 1 (3%) patient.


CONCLUSIONS
Most patients undergoing PD have evidence of a PM. A subset of patients may have lesions that mimic a PM. In these patients, when PM cannot be ruled out, if possible, they should be offered PD.
Department of Surgery, Division of Surgical Oncology, Loyola University Medical Center, 2160 S First Avenue, Maywood, IL 60153, USA.
Michael G
MG
Hurtuk
Margo
M
Shoup
Kiyoko
K
Oshima
Sherri
S
Yong
Gerard V
GV
Aranha
D000328:Adult; D000368:Aged; D014670:Ampulla of Vater; D003138:Common Bile Duct Neoplasms / Q000473:pathology* / Q000601:surgery*; D003951:Diagnostic Errors; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016577:Pancreaticoduodenectomy; D012189:Retrospective Studies; D055815:Young Adult