Affiliation
Liver Unit, St Vincent's University Hospital, Elm Park, Dublin. dara_kav@hotmail.comIssue Date
2008MeSH
AdultAged
Female
Follow-Up Studies
Humans
Male
Middle Aged
Pancreatic Diseases
Pancreaticoduodenectomy
Tomography, X-Ray Computed
Metadata
Show full item recordCitation
Radical pancreaticoduodenectomy for benign disease. 2008, 8:1156-67 ScientificWorldJournalPublisher
The Scientific World JournalJournal
The Scientific World JournalDOI
10.1100/tsw.2008.147PubMed ID
19030761Abstract
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
enISSN
1537-744Xae974a485f413a2113503eed53cd6c53
10.1100/tsw.2008.147
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