Pancreatic cancer in chronic pancreatitis – the diagnostic and therapeutic dilemma; an overview of cases

Česká verze

Authors: M. Loveček ¹; P. Skalický ² ; J. Tesaříková ¹; O. Urban ³; Přemysl Falt ³ ; D. Kurfúrstová ⁴; Dušan Klos ²
Authors place of work: I. chirurgická klinika Fakultní nemocnice Olomouc ¹; I. chirurgická klinika Lékařské fakulty Univerzity Palackého Olomouc ²; II. interní gastroenterologická – geriatrická klinika Fakultní nemocnice Olomouc ³; Ústav klinické a molekulární patologie Lékařské fakulty Univerzity Palackého Olomouc ⁴
Published in the journal: Rozhl. Chir., 2022, roč. 101, č. 11, s. 549-550.
Category: Kazuistika
doi: https://doi.org/10.33699/PIS.2022.101.11.549–556

Summary

Introduction: Any mass in chronic pancreatitis (CP) is a difficult diagnostic and therapeutic problem. The aim of the study is a) to use our own group to determine the actual incidence of non-malignant masses in CP where any mass is highly suspected of being malignant; and b) to determine the actual incidence of malignant tumors in CP.

Methods: We present a retrospective analysis of our group of patients operated in 2015–2019 for CP, a mass in CP and suspected malignancy in the mass in CP. Additionally, we present difficult cases in terms of preoperative diagnosis.

Results: Thirty-three of 340 (9.7%) pancreatic resection were done due to any form of chronic pancreatitis in 2015–2019. A mass in the pancreatic head was present in 16 (48%) patients; of these, pancreatic ductal adenocarcinoma (PDAC) was suspected in 10 (62%) patients based on EUS, CT or PETCT, and also based on positive tissue diagnosis using EUS-FNA in 6 cases. Bypass or Frey procedure were done in 59 patients (HJA, PJA, Frey). Preoperative tissue sampling was done in 8 (13%) patients and malignancy was suspected in 25%. Intraoperatively, malignancy was confirmed only in one patient assessed as non-malignant in the preoperative period. The clinical course in 3 other patients undergoing HJA, although tumor-free at the time of the surgery, indicated PDAC in CP.

Conclusion: The ability to detect malignant cells in a mass in CP remains poor even using all of the available sophisticated methods and the success depends on many variable factors. The rate of “unnecessary” right-sided resections of a mass in CP reached 48% in our patient group, while the rate of resections which should have been performed instead of bypass procedures was 7%. A certain percentage of the so-called excessive pancreatic resections, as well as the failure to perform a resection due to an undetected/unrecognized pancreatic tumor in CP should continue to be expected.

Keywords:

Pancreatic cancer – Pancreas – chronic pancreatitis – case reports – non-malignant mass

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