Winter Jordan M, Cameron John L, Lillemoe Keith D, Campbell Kurtis A, Chang David, Riall Taylor S, Coleman Joann, Sauter Patricia K, Canto Marcia, Hruban Ralph H, Schulick Richard D, Choti Michael A, Yeo Charles J
Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
Ann Surg. 2006 May;243(5):673-80; discussion 680-3. doi: 10.1097/01.sla.0000216763.27673.97.
While incidental masses in certain organs have received particular attention, periampullary and pancreatic incidentalomas (PIs) remain poorly characterized.
We reviewed 1944 consecutive pancreaticoduodenectomies (PD) over an 8-year period (April 1997 to October 2005). A total of 118 patients (6% of all PDs) presented with an incidental finding of a periampullary or pancreatic mass. The PI patients were analyzed and compared with the rest of the cohort (NI, nonincidentaloma group, n = 1826).
Thirty-one percent of the PI patients (n = 37) had malignant disease (versus 76% of the NI patients, P < 0.001), 47% (n = 55) had premalignant disease, and the remaining 22% (n = 26) had little or no risk for malignant progression. The 3 most common diagnoses in the PI group were IPMN without invasive cancer (30%), cystadenoma (17%), and pancreatic ductal adenocarcinoma (10%). The PI group had a higher overall complication rate (55% versus 43%, P = 0.02), due in part to a significantly increased rate of pancreatic fistulas (18.4% PI versus 8.5% NI, P < 0.001). Patients in the PI group with malignant disease had a superior long-term survival (median, 30 months, P = 0.01) compared with patients in the NI group with malignant disease (median, 21 months).
Incidentally discovered periampullary and pancreatic masses comprise a substantial proportion of patients undergoing PD. Roughly three fourths of these lesions are malignant or premalignant, and amenable to curative resection. Resected malignant PIs have favorable pathologic features as compared with resected malignant NIs, and resection of these early lesions in asymptomatic individuals is associated with improved survival, compared with patients with symptomatic disease.
虽然某些器官中的偶然发现的肿块受到了特别关注，但壶腹周围和胰腺偶然瘤（PI）的特征仍不明确。
我们回顾了8年期间（1997年4月至2005年10月）连续进行的1944例胰十二指肠切除术（PD）。共有118例患者（占所有PD的6%）偶然发现壶腹周围或胰腺肿块。对PI患者进行分析，并与其余队列（NI，非偶然瘤组，n = 1826）进行比较。
31%的PI患者（n = 37）患有恶性疾病（而NI患者为76%，P < 0.001），47%（n = 55）患有癌前疾病，其余22%（n = 26）发生恶性进展的风险很小或没有风险。PI组最常见的3种诊断为无浸润癌的胰管内乳头状黏液瘤（IPMN）（30%）、囊腺瘤（17%）和胰腺导管腺癌（10%）。PI组的总体并发症发生率较高（55%对43%，P = 0.02），部分原因是胰瘘发生率显著增加（PI组为18.4%，NI组为8.5%，P < 0.001）。与患有恶性疾病的NI组患者（中位数为21个月）相比，PI组患有恶性疾病的患者长期生存率更高（中位数为30个月，P = 0.01）。
偶然发现的壶腹周围和胰腺肿块在接受PD的患者中占相当大的比例。这些病变中约四分之三是恶性或癌前病变，适合进行根治性切除。与切除的恶性NI相比，切除的恶性PI具有良好的病理特征，与有症状疾病的患者相比，对无症状个体的这些早期病变进行切除与生存率提高相关。
