Radical pancreaticoduodenectomy for benign disease.

Hdl Handle:
http://hdl.handle.net/10147/251956
Title:
Radical pancreaticoduodenectomy for benign disease.
Authors:
Kavanagh, D O; O'Riain, C; Ridgway, P F; Neary, P; Crotty, T C; Geoghegan, J G; Traynor, O
Affiliation:
Liver Unit, St Vincent's University Hospital, Elm Park, Dublin. dara_kav@hotmail.com
Citation:
Radical pancreaticoduodenectomy for benign disease. 2008, 8:1156-67 ScientificWorldJournal
Publisher:
The Scientific World Journal
Journal:
The Scientific World Journal
Issue Date:
2008
URI:
http://hdl.handle.net/10147/251956
DOI:
10.1100/tsw.2008.147
PubMed ID:
19030761
Abstract:
Whipple's procedure is the treatment of choice for pancreatic and periampullary malignancies. Preoperative histological confirmation of malignancy is frequently unavailable and some patients will subsequently be found to have benign disease. Here, we review our experience with Whipple's procedure for patients ultimately proven to have benign disease. The medical records of all patients who underwent Whipple's procedure during a 15-year period (1987-2002) were reviewed; 112 patients underwent the procedure for suspected malignancy. In eight cases, the final histology was benign (7.1%). One additional patient was known to have benign disease at resection. The mean age was 50 years (range: 30-75). The major presenting features included jaundice (five), pain (two), gastric outlet obstruction (one), and recurrent gastrointestinal haemorrhage (one). Investigations included ultrasound (eight), computerised tomography (eight), endoscopic retrograde cholangiopancreatography (seven; of these, four patients had a stent inserted and three patients had sampling for cytology), and endoscopic ultrasound (two). The pathological diagnosis included benign biliary stricture (two), chronic pancreatitis (two), choledochal cyst (one), inflammatory pseudotumour (one), cystic duodenal wall dysplasia (one), duodenal angiodysplasia (one), and granular cell neoplasm (one). There was no operative mortality. Morbidity included intra-abdominal collection (one), anastomotic leak (one), liver abscess (one), and myocardial infarction (one). All patients remain alive and well at mean follow-up of 41 months. Despite recent advances in diagnostic imaging, 8% of the patients undergoing Whipple's procedure had benign disease. A range of unusual pathological entities can mimic malignancy. Accurate preoperative histological diagnosis may have allowed a less radical operation to be performed. Endoscopic ultrasound-guided fine needle aspirate (EUS-FNA) may reduce the need for Whipple's operation in benign pancreaticobiliary disease in the future.
Language:
en
MeSH:
Adult; Aged; Female; Follow-Up Studies; Humans; Male; Middle Aged; Pancreatic Diseases; Pancreaticoduodenectomy; Tomography, X-Ray Computed
ISSN:
1537-744X

Full metadata record

DC FieldValue Language
dc.contributor.authorKavanagh, D Oen_GB
dc.contributor.authorO'Riain, Cen_GB
dc.contributor.authorRidgway, P Fen_GB
dc.contributor.authorNeary, Pen_GB
dc.contributor.authorCrotty, T Cen_GB
dc.contributor.authorGeoghegan, J Gen_GB
dc.contributor.authorTraynor, Oen_GB
dc.date.accessioned2012-11-13T11:21:20Z-
dc.date.available2012-11-13T11:21:20Z-
dc.date.issued2008-
dc.identifier.citationRadical pancreaticoduodenectomy for benign disease. 2008, 8:1156-67 ScientificWorldJournalen_GB
dc.identifier.issn1537-744X-
dc.identifier.pmid19030761-
dc.identifier.doi10.1100/tsw.2008.147-
dc.identifier.urihttp://hdl.handle.net/10147/251956-
dc.description.abstractWhipple's procedure is the treatment of choice for pancreatic and periampullary malignancies. Preoperative histological confirmation of malignancy is frequently unavailable and some patients will subsequently be found to have benign disease. Here, we review our experience with Whipple's procedure for patients ultimately proven to have benign disease. The medical records of all patients who underwent Whipple's procedure during a 15-year period (1987-2002) were reviewed; 112 patients underwent the procedure for suspected malignancy. In eight cases, the final histology was benign (7.1%). One additional patient was known to have benign disease at resection. The mean age was 50 years (range: 30-75). The major presenting features included jaundice (five), pain (two), gastric outlet obstruction (one), and recurrent gastrointestinal haemorrhage (one). Investigations included ultrasound (eight), computerised tomography (eight), endoscopic retrograde cholangiopancreatography (seven; of these, four patients had a stent inserted and three patients had sampling for cytology), and endoscopic ultrasound (two). The pathological diagnosis included benign biliary stricture (two), chronic pancreatitis (two), choledochal cyst (one), inflammatory pseudotumour (one), cystic duodenal wall dysplasia (one), duodenal angiodysplasia (one), and granular cell neoplasm (one). There was no operative mortality. Morbidity included intra-abdominal collection (one), anastomotic leak (one), liver abscess (one), and myocardial infarction (one). All patients remain alive and well at mean follow-up of 41 months. Despite recent advances in diagnostic imaging, 8% of the patients undergoing Whipple's procedure had benign disease. A range of unusual pathological entities can mimic malignancy. Accurate preoperative histological diagnosis may have allowed a less radical operation to be performed. Endoscopic ultrasound-guided fine needle aspirate (EUS-FNA) may reduce the need for Whipple's operation in benign pancreaticobiliary disease in the future.en_GB
dc.language.isoenen
dc.publisherThe Scientific World Journalen_GB
dc.rightsArchived with thanks to TheScientificWorldJournalen_GB
dc.subject.meshAdult-
dc.subject.meshAged-
dc.subject.meshFemale-
dc.subject.meshFollow-Up Studies-
dc.subject.meshHumans-
dc.subject.meshMale-
dc.subject.meshMiddle Aged-
dc.subject.meshPancreatic Diseases-
dc.subject.meshPancreaticoduodenectomy-
dc.subject.meshTomography, X-Ray Computed-
dc.titleRadical pancreaticoduodenectomy for benign disease.en_GB
dc.contributor.departmentLiver Unit, St Vincent's University Hospital, Elm Park, Dublin. dara_kav@hotmail.comen_GB
dc.identifier.journalThe Scientific World Journalen_GB
dc.description.provinceLeinsteren

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