title: Surgery for pancreatic neoplasms: How accurate are our surgical indications?
abstract: Accurate preoperative diagnosis is critical for the determination of appropriate surgical indications. The aim of this study was to assess the accuracy of preoperative diagnosis and indications for operative therapy for presumed pancreatic neoplasms.
  
  
  
  From 2005 to 2013, 851 patients underwent pancreatectomies for presumed pancreatic neoplasms. A formal preoperative diagnosis was established during a multidisciplinary tumor board and compared to the final pathologic examination. The preoperative diagnosis and its accuracy were assessed according to demographics, symptoms, and diagnostic workup.
  
  
  
  Tumors were benign in 8% of patients (n = 67), premalignant in 43% (n = 370), and malignant in 49% (n = 414). The mean number of preoperative examinations was 3.2; 27% (n = 144) of patients had computed tomography, magnetic resonance imaging, endoscopic ultrasonography, and fine needle examination all performed together. Preoperative diagnosis was confirmed in 89% of patients (n = 754). The morbidity and mortality rates were 65% and 1%, respectively. Of the 97 patients (11%) with a misdiagnosis, operative resection was ultimately relevant (premalignant, malignant tumor, or symptomatic benign tumor) in 51 (6%) but inappropriate in 46 (5%). The rate of misdiagnosis was increased for cystic lesions and in patients under 50 years of age. For lesions <2 cm, diagnostic accuracy was increased when computed tomography, magnetic resonance imaging, endoscopic ultrasonography, and fine needle examination were all performed together.
  
  
  
  Misdiagnosis can lead to an inappropriate resection in 5% of patients with presumed pancreatic neoplasms. For lesions difficult to characterize, such as small and cystic lesions, association of several modalities of preoperative workup could help to decrease the rate of inappropriate operative care.
authors.affiliation: AP-HP, Hôpital Beaujon, Department of Hepato-Pancreato-Biliary Surgery, Pôle des Maladies de l'Appareil Digestif (PMAD), DHU Unity, Clichy, France.
authors.forename: David Jérémie
authors.initials: DJ
authors.lastname: Birnbaum
authors.affiliation: AP-HP, Hôpital Beaujon, Department of Hepato-Pancreato-Biliary Surgery, Pôle des Maladies de l'Appareil Digestif (PMAD), DHU Unity, Clichy, France; Université Paris Diderot, Paris, France; Institut National de la Santé et de la Recherche Médicale, Centre de Recherche Biomédicale Bichat Beaujon (CRB3)/INSERM U773, Clichy, France.
authors.forename: Sébastien
authors.initials: S
authors.lastname: Gaujoux
authors.affiliation: AP-HM, Hospital Timone, EA3279 Self-perceived Health Assessment Research Unit and Department of Public Health, Aix-Marseille University, Marseille, France.
authors.forename: Julie
authors.initials: J
authors.lastname: Berbis
authors.affiliation: AP-HP, Hôpital Beaujon, Department of Hepato-Pancreato-Biliary Surgery, Pôle des Maladies de l'Appareil Digestif (PMAD), DHU Unity, Clichy, France.
authors.forename: Safi
authors.initials: S
authors.lastname: Dokmak
authors.affiliation: Université Paris Diderot, Paris, France; AP-HP, Hôpital Beaujon, Department of Gastroenterology, Pôle des Maladies de l'Appareil Digestif (PMAD), DHU Unity, Clichy, France.
authors.forename: Pascal
authors.initials: P
authors.lastname: Hammel
authors.affiliation: AP-HP, Hôpital Beaujon, Department of Radiology, Clichy, France.
authors.forename: Marie Pierre
authors.initials: MP
authors.lastname: Vullierme
authors.affiliation: Université Paris Diderot, Paris, France; AP-HP, Hôpital Beaujon, Department of Gastroenterology, Pôle des Maladies de l'Appareil Digestif (PMAD), DHU Unity, Clichy, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Lévy
authors.affiliation: AP-HP, Hôpital Beaujon, Department of Hepato-Pancreato-Biliary Surgery, Pôle des Maladies de l'Appareil Digestif (PMAD), DHU Unity, Clichy, France; Université Paris Diderot, Paris, France. Electronic address: alain.sauvanet@aphp.fr.
authors.forename: Alain
authors.initials: A
authors.lastname: Sauvanet
mesh_terms: D000328:Adult; D000368:Aged; D003951:Diagnostic Errors; D019160:Endosonography; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery*; D018579:Patient Selection; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012307:Risk Factors; D014057:Tomography, X-Ray Computed