INCIDENCE AND CLINICAL FINDINGS OF BENIGN, INFLAMMATORY DISEASE IN PATIENTS RESECTED FOR PRESUMED PANCREATIC HEAD CANCER

Background: The differentiation between cancer and benign disease in t he pancreatic head is difficult. The aim of this study was to examine common features in a group of patients that had undergone pancreatoduo denectomy fdr a benign, inflammatory lesion misdiagnosed as pancreatic head cancer. Methods: Among 220 pancreatoduodenectomies performed on the suspicion of pancreatic head cancer, an inflammatory lesion in the pancreas or distal common bile duct was diagnosed in 14 patients (6%) . Of these patients, all preoperative clinical information and radiolo gic images (ultrasound, endoscopic retrograde cholangio-pancreaticogra phy [ERCP]) were critically reassessed. For each examination, the susp icion of cancer was scored on a 0/+/++ scale. Results: Clinical presen tation (pain, weight loss, jaundice) raised a suspicion of cancer in 1 2 patients. On ultrasound, a tumor (mean size: 2.8 cm) was found in th e pancreatic head in 13 patients; 12 of 14 ultrasound examinations rai sed a suspicion of cancer. ERCP showed a distal common bile duct steno sis (length: 1 to 4 cm), stenosis of the pancreatic duct (length: 1 to 5 cm), or a ''double duct'' stenosis, suspicious for cancer in 13 eva luable patients. The overall index of suspicion was + in seven patient s and ++ in seven patients, confirming the initial interpretation of p reoperative data. Conclusion: When undertaking pancreatoduodenectomy f or a suspicious lesion in the pancreatic head, it is necessary to expe ct at least a 5% chance of resecting a benign, inflammatory lesion mas querading as cancer.