Incidence and characteristics of chronic and lymphoplasmacytic sclerosing pancreatitis in patients scheduled to undergo a pancreatoduodenectomy.
BACKGROUND
The determination of the exact nature of a pancreatic head mass in a patient scheduled to undergo a pancreatoduodenectomy can be very difficult. This is important as patients who suffer from benign disease such as pancreatitis do not always require surgery. The aim of the present study was to analyse the incidence of pancreatitis and the signs and symptoms associated with these tumours mistaken for pancreatic cancer and the diagnostic procedures performed.


METHODS
A consecutive group of patients who underwent a pancreatoduodenectomy between 1992 and 2005 with histopathologically proven pancreatic adenocarcinoma (PCA) and pancreatitis were analysed.


RESULTS
The incidence of pancreatitis after pancreatoduodenectomy is 63 out of 639 patients who underwent a pancreaticoduodenectomy (9.9%). Of these patients, 24 patients (38%) had lymphoplasmacytic sclerosing pancreatitis (LPSP) and 31 patients (49%) had focal chronic pancreatitis. Eight patients (13%) had an intermediate form with characteristics of both. Pancreatic adenocarcinoma occurred in 227 patients (36%). The presence of pancreatitis without a discrete mass on endoscopic ultrasonography (EUS) seemed to have clinical relevance with a positive likelihood ratio of 5.1. Mortality after resection was nil in both groups.


CONCLUSIONS
The incidence of pancreatitis is 9.9% for patients scheduled to undergo a pancreatoduodenectomy. Of these patients, 38% had LPSP, 13% had a intermediate form and 49% had focal chronic pancreatitis. The determination of the exact nature of a pancreatic head mass remains difficult.
de Castro
Steve M M
SM
Department of Surgery, Academic Medical Center, Meibergdreef 9, Amsterdam,the Netherlands.
de Nes
Lindsey C F
LC
Nio
C Yung
CY
Velseboer
Daan C
DC
ten Kate
Fiebo J W
FJ
Busch
Olivier R C
OR
van Gulik
Thomas M
TM
Gouma
Dirk Jan
DJ
D000230:Adenocarcinoma / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D000328:Adult; D000368:Aged; D001327:Autoimmune Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D002760:Cholangiopancreatography, Endoscopic Retrograde; D049448:Cholangiopancreatography, Magnetic Resonance; D003951:Diagnostic Errors; D017558:Elective Surgical Procedures; D019160:Endosonography; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects; D050500:Pancreatitis, Chronic / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D011237:Predictive Value of Tests; D012598:Sclerosis; D036542:Tomography, Spiral Computed; D016896:Treatment Outcome; D019564:Unnecessary Procedures