Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA.
J Gastrointest Surg. 2010 Jul;14(7):1139-42. doi: 10.1007/s11605-010-1196-9. Epub 2010 Apr 28.
The lack of accurate markers makes preoperative differentiation between pancreatic cancer and non-malignant head lesions clinically challenging. In this study, we investigated the incidence of benign disease in patients that underwent resection for presumed pancreatic cancer diagnosed by EUS and EUS-guided FNA.
Medical records of consecutive patients who underwent pancreaticoduodenectomy at Duke University were reviewed. Demographics, clinicopathologic characteristics, preoperative imaging, EUS, EUS-guided FNA, and postoperative outcomes were analyzed.
Seven percent of the total 494 patients studied were found to have benign disease on postoperative pathology. Fifty-nine percent of these patients with benign disease underwent preoperative EUS. EUS was positive for a head mass in 70%, demonstrated enlarged lymph nodes in 27%, and showed signs concerning for vascular invasion in 13%. FNA was suspicious or indeterminate for cancer in 63% of patients. Postoperative complications occurred in 47% and one patient died after surgery. The overall pancreatic leak rate was 15%.
Even with aggressive use of preoperative evaluation, there is still a small subset of patients where malignancy cannot be excluded without pancreaticoduodenectomy.
缺乏准确的标志物使得术前区分胰腺癌和非恶性头部病变具有临床挑战性。本研究调查了经超声内镜（EUS）和 EUS 引导下细针抽吸活检（FNA）诊断为胰腺癌而接受切除术的患者中良性疾病的发生率。
回顾了在杜克大学接受胰十二指肠切除术的连续患者的病历。分析了人口统计学、临床病理特征、术前影像学、EUS、EUS 引导下 FNA 和术后结果。
在研究的 494 名患者中，有 7%的患者术后病理为良性疾病。这些良性疾病患者中有 59%接受了术前 EUS。EUS 对头部肿块的阳性率为 70%，显示淋巴结肿大的占 27%，显示血管侵犯征象的占 13%。FNA 对 63%的患者怀疑或不确定为癌症。术后并发症发生率为 47%，1 例患者术后死亡。总的胰漏发生率为 15%。
即使术前评估积极，仍有一小部分患者需要行胰十二指肠切除术才能排除恶性肿瘤。
