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    Radical pancreaticoduodenectomy for benign disease.

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    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
    Issue Date
    2008
    MeSH
    Adult
    Aged
    Female
    Follow-Up Studies
    Humans
    Male
    Middle Aged
    Pancreatic Diseases
    Pancreaticoduodenectomy
    Tomography, X-Ray Computed
    
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    Citation
    Radical pancreaticoduodenectomy for benign disease. 2008, 8:1156-67 ScientificWorldJournal
    Publisher
    The Scientific World Journal
    Journal
    The Scientific World Journal
    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
    ISSN
    1537-744X
    ae974a485f413a2113503eed53cd6c53
    10.1100/tsw.2008.147
    Scopus Count
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    Tallaght University Hospital

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