title: Preoperative characteristics of patients with presumed pancreatic cancer but ultimately benign disease: a multicenter series of 344 pancreatoduodenectomies.
abstract: BACKGROUND
  Preoperative differentiation between malignant and benign pancreatic tumors can be difficult. Consequently, a proportion of patients undergoing pancreatoduodenectomy for suspected malignancy will ultimately have benign disease. The aim of this study was to compare preoperative clinical and diagnostic characteristics of patients with unexpected benign disease after pancreatoduodenectomy with those of patients with confirmed (pre)malignant disease.
  
  
  METHODS
  We performed a multicenter retrospective cohort study in 1,629 consecutive patients undergoing pancreatoduodenectomy for suspected malignancy between 2003 and 2010 in 11 Dutch centers. Preoperative characteristics were compared in a benign:malignant ratio of 1:3. Malignant cases were selected from the entire cohort by using a random number list. A multivariable logistic regression prediction model was constructed to predict benign disease.
  
  
  RESULTS
  Of 107 patients (6.6 %) with unexpected benign disease after pancreatoduodenectomy, 86 fulfilled the inclusion criteria and were compared with 258 patients with (pre)malignant disease. Patients with benign disease presented more often with pain (56 vs. 38 %; P = 0.004), but less frequently with jaundice (60 vs. 80 %; P < 0.01), a pancreatic mass (13 vs. 54 %, P < 0.001), or a double duct sign on computed tomography (21 vs. 47 %; P < 0.001). In a prediction model using these parameters, only 19 % of patients with benign disease were correctly predicted, and 1.4 % of patients with malignant disease were missed.
  
  
  CONCLUSIONS
  Nearly 7 % of patients undergoing pancreatoduodenectomy for suspected malignancy were ultimately diagnosed with benign disease. Although some preoperative clinical and imaging characteristics might indicate absence of malignancy, their discriminatory value is insufficient for clinical use.
authors.affiliation: Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Arja
authors.initials: A
authors.lastname: Gerritsen
authors.forename: I Quintus
authors.initials: IQ
authors.lastname: Molenaar
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Bollen
authors.forename: C Yung
authors.initials: CY
authors.lastname: Nio
authors.forename: Marcel G
authors.initials: MG
authors.lastname: Dijkgraaf
authors.forename: Hjalmar C
authors.initials: HC
authors.lastname: van Santvoort
authors.forename: G Johan
authors.initials: GJ
authors.lastname: Offerhaus
authors.forename: Lodewijk A
authors.initials: LA
authors.lastname: Brosens
authors.forename: Katharina
authors.initials: K
authors.lastname: Biermann
authors.forename: Egbert
authors.initials: E
authors.lastname: Sieders
authors.forename: Koert P
authors.initials: KP
authors.lastname: de Jong
authors.forename: Ronald M
authors.initials: RM
authors.lastname: van Dam
authors.forename: Erwin
authors.initials: E
authors.lastname: van der Harst
authors.forename: Harry
authors.initials: H
authors.lastname: van Goor
authors.forename: Bert
authors.initials: B
authors.lastname: van Ramshorst
authors.forename: Bert A
authors.initials: BA
authors.lastname: Bonsing
authors.forename: Ignace H
authors.initials: IH
authors.lastname: de Hingh
authors.forename: Michael F
authors.initials: MF
authors.lastname: Gerhards
authors.forename: Casper H
authors.initials: CH
authors.lastname: van Eijck
authors.forename: Dirk J
authors.initials: DJ
authors.lastname: Gouma
authors.forename: Inne H M
authors.initials: IH
authors.lastname: Borel Rinkes
authors.forename: Olivier R C
authors.initials: OR
authors.lastname: Busch
authors.forename: Marc G
authors.initials: MG
authors.lastname: Besselink
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis* / Q000601:surgery; D000236:Adenoma / Q000175:diagnosis* / Q000601:surgery; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010190:Pancreatic Neoplasms / Q000175:diagnosis* / Q000601:surgery; D016577:Pancreaticoduodenectomy; D011300:Preoperative Care; D011379:Prognosis; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed