title: Pancreatic head cancer in patients with chronic pancreatitis.
abstract: BACKGROUND
  Chronic pancreatitis (CP) is a risk factor of pancreatic adenocarcinoma (PA). The discovery of a pancreatic head lesion in CP frequently leads to a pancreaticoduodenectomy (PD) which preceded by a multidisciplinary meeting (MM). The aim of this study was to evaluate the relevance between this indication of PD and the definitive pathological results.
  
  
  METHODS
  Between 2000 and 2010, all patients with CP who underwent PD for suspicion of PA without any histological proof were retrospectively analyzed. The operative decision has always been made at an MM. The definitive pathological finding was retrospectively confronted with the decision made at an MM, and patients were classified in two groups according to this concordance (group 1) or not (group 2). Clinical and biological parameters were analyzed, preoperative imaging were reread, and confronted to pathological findings in order to identify predictive factors of malignant degeneration.
  
  
  RESULTS
  During the study period, five of 18 (group 1) patients with CP had PD were histologically confirmed to have PA, and the other 13 (group 2) did not have PA. The median age was 52.5+/-8.2 years (gender ratio 3.5). The main symptoms were pain (94.4%) and weight loss (72.2%). There was no patient's death. Six (33.3%) patients had a major complication (Clavien-Dindo classification ≥ 3). There was no statistical difference in clinical and biological parameters between the two groups. The rereading of imaging data could not detect efficiently all patients with PA.
  
  
  CONCLUSIONS
  Our results confirmed the difficulty in detecting malignant transformation in patients with CP before surgery and therefore an elevated rate of unnecessary PD was found. A uniform imaging protocol is necessary to avoid PD as a less invasive treatment could be proposed.
authors.affiliation: Service de Chirurgie Hepatobiliaire et Digestive, Hopital Pontchaillou, Centre Hospitalier Universitaire, Universite de Rennes 1, Rennes, France; INSERM UMR991, Foie, Metabolismes et Cancer, Universite de Rennes 1, Rennes, France. laurent.sulpice@chu-rennes.fr.
authors.forename: Aude
authors.initials: A
authors.lastname: Merdrignac
authors.forename: Laurent
authors.initials: L
authors.lastname: Sulpice
authors.forename: Michel
authors.initials: M
authors.lastname: Rayar
authors.forename: Tanguy
authors.initials: T
authors.lastname: Rohou
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Quehen
authors.forename: Ayman
authors.initials: A
authors.lastname: Zamreek
authors.forename: Karim
authors.initials: K
authors.lastname: Boudjema
authors.forename: Bernard
authors.initials: B
authors.lastname: Meunier
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D003951:Diagnostic Errors / Q000517:prevention & control; D003952:Diagnostic Imaging; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D016577:Pancreaticoduodenectomy; D050500:Pancreatitis, Chronic / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D019564:Unnecessary Procedures