Correlation of indications for pancreatic resection with histopathological finding

Czech version

Authors: A. Pulkertová ¹; J. Špičák ¹; V. Gábriš ²; D. Kautznerová ³; M. Kučera ⁴; M. Oliverius ⁴
Authors‘ workplace: Klinika hepatogastroenterologie, IKEM, Praha, 2Pracoviště klinické a transplantační patologie, IKEM, Praha, 3Pracoviště radiodiagnostiky a intervenční radiologie, IKEM, Praha, 4Klinika transplantační chirurgie, IKEM, Praha ¹
Published in: Gastroent Hepatol 2012; 66(3): 191-195
Category: Clinical and Experimental Gastroenterology: Original Article

Overview

Diagnosing malignant and benign diseases of the pancreas is a major problem due to the following differing treatment strategies. Surgical treatment is essential for resecable pancreatic adenocarcinoma and it is not indicated for locally advanced or metastatic lesions or for benign tumours. In chronic pancreatitis surgery is indicated only in certain cases. It is common that histopathological findings significantly correct prior diagnosis. The aim of this study was to identify the correlation of clinical and histopathological diagnoses.

Methods:
We retrospectively analyzed a set of patients who had undergone pancreatic resection at the Institute for Clinical and Experimental Medicine without taking the previous indication into consideration and compared the clinical and histopathological diagnoses.

Results:
The most common indication for surgery was the suspicion of malignant focal process in pancreatic parenchyma (220 of 362; 61%). This finding was confirmed in 133 of them (60%). Especially the evaluated tumour of Vater’s ampulla was an indication for surgery in 48 patients and confirmed in 33 (69%) of them. 59 (16%) patients were indicated for surgery for complications of chronic pancreatitis: the diagnosis was confirmed in 44 (74%) of them, while in 12 (20%) of them a malignant tumour was detected. Autoimmune pancreatitis was diagnosed in 14 (4%) cases, 11 of them were indicated for surgery due to suspicion of malignancy. The overall indication correlated with the histopathological finding only in 189 (52%) cases.

Conclusion:
Discrepancies between preoperative diagnosis and definitive histopathological conclusion were frequent. Autoimmune pancreatitis was not an exceptional (false) indication for surgery. It is necessary to refine and systematize the preoperative examination.

Key words:
autoimmune pancreatitis – chronic pancreatitis – pancreatic malignancy – pancreatic resection

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