CAJ | 학술논문

BACKGROUND:?Chronic?pancreatitis?(CP)?is?a?risk?factor?of?pancreatic?adenocarcinoma?(PA).?The?discovery?of?a?pancreatic?head? lesion? in? CP? frequently? leads? to? a? pancreaticoduo- denectomy?(PD)?which?preceded?by?a?multidisciplinary?meeting?(MM).?The?aim?of?this?study?was?to?evaluate?the?relevance?between?this?indication?of?PD?and?the?deifnitive?pathological?results. <br> METHODS:?Between?2000?and?2010,?all?patients?with?CP?who?underwent?PD?for?suspicion?of?PA?without?any?histological?proof?were?retrospectively?analyzed.?The?operative?decision?has?always?been?made?at?an?MM.?The?deifnitive?pathological?ifnding?was?retrospectively?confronted?with?the?decision?made?at?an?MM,?and?patients?were?classiifed?in?two?groups?according?to?this?concordance?(group?1)?or?not?(group?2).?Clinical?and?biological?parameters?were?analyzed,?preoperative?imaging?were?reread,?and?confronted?to?pathological?ifndings?in?order?to?identify?predictive?factors?of?malignant?degeneration. <br> RESULTS:?During?the?study?period,?ifve?of?18?(group?1)?patients?with?CP?had?PD?were?histologically?conifrmed?to?have?PA,?and?the?other?13?(group?2)?did?not?have?PA.?The?median?age?was?52.5?±8.2?years?(gender?ratio?3.5).?The?main?symptoms?were?pain?(94.4%)?and?weight?loss?(72.2%).?There?was?no?patient's?death.?Six?(33.3%)?patients?had?a?major?complication?(Clavien- Dindo?classiifcation?≥3).?There?was?no?statistical?difference?in?clinical?and?biological?parameters?between?the?two?groups.?The?rereading?of?imaging?data?could?not?detect?efifciently?all?patients?with?PA. <br> CONCLUSIONS:?Our? results? conifrmed? the? dififculty? in?detecting?malignant?transformation?in?patients?with?CP?before?surgery?and?therefore?an?elevated?rate?of?unnecessary?PD?was?found.?A?uniform?imaging?protocol?is?necessary?to?avoid?PD?as?a?less?invasive?treatment?could?be?proposed.