CARCINOMA OF THE HEAD OF THE PANCREAS ARISING FROM THE UNCINATE PROCESS

Background Carcinoma located in the uncinate process (CUP) of the panc reatic head is considered to be rare. Exact epidemiological data, howe ver, are not available because the series published so far consist of fewer than ten patients. The purpose of this prospective study was to evaluate the clinical appearance of CUP and to compare findings with t hose of patients with carcinoma in the ventral aspect of the pancreati c head (VPC), which represents the most frequent localization. Results Some 39 (8 per cent) of 506 evaluated patients suffered from CUP. Mea n age was 63.3 years. The most frequent complaints were upper abdomina l pain (n = 32) and weight loss (n = 35). Jaundice was seen in only fi ve patients and was never an early symptom. The level of CA19-9 was ra ised in 33 patients, The best diagnostic procedure to detect CUP was c omputed tomography (CT) (sensitivity 93 per cent), whereas endoscopic retrograde cholangiopancreatography was not useful (sensitivity 21 per cent). Vascular involvement was significantly (P < 0.01) more common in CUP (n = 19) than in VPC (48 versus 19 per cent). This finding and the fact that most patients with CUP were diagnosed at a late stage wi th distant metastasis or severe vascular involvement present (n = 21) are responsible for the significantly lower rate of operation (n = 25) (64 versus 92 pet cent, p < 0.05) and the significantly shorter media n survival time (5 versus 11 months, P < 0.5). Conclusion Patients wit h CUP have a poor prognosis as a result of the lack of early symptoms (jaundice) and early vascular involvement due to the proximity of the uncinate process to the mesenteric root. A raised level of CA19-9, tog ether with weight loss and/or upper abdominal pain, should prompt CT.