Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan.
Department of Gastroenterology and Hepatology, Faculty of Medicine, Kindai University, Osakasayama, Osaka, Japan.
J Gastroenterol. 2024 Dec;59(12):1133-1142. doi: 10.1007/s00535-024-02149-0. Epub 2024 Sep 16.
Focal pancreatic parenchymal atrophy (FPPA) and upstream pancreatic atrophy (UPA) may indicate the presence of early pancreatic cancer. In early pancreatic cancer, the tumor occasionally spreads laterally along the main pancreatic duct, presenting challenges in determining the extent of surgical resection. This study aimed to investigate the association of pancreatic atrophy pattern and intraductal cancer extension.
Thirty-two patients with early-stage pancreatic cancer who underwent surgery at five participating centers were enrolled. Pancreatic atrophy was defined as the narrowing of parenchyma compared to the surrounding parenchyma and was classified as either FPPA (partial atrophy surrounding the pancreatic duct stenosis) or UPA (global atrophy caudal to the site of duct stenosis). Intraductal cancer extension was defined as an extension exceeding 10 mm.
Preoperative computed tomography revealed FPPA, UPA, and no parenchymal atrophy in 13, 13, and 6 patients. Cases with FPPA or UPA showed significantly longer cancer extensions than those without atrophy (P = 0.005 and P = 0.03, respectively). Intraductal cancer extension was present in all but one case of FPPA. 69% (9/13) of the cases with UPA showed intraductal cancer extension, whereas cases without atrophy showed no intraductal cancer extension. Importantly, two patients with FPPA or UPA showed positive resection margins during surgery and three patients with FPPA or UPA showed recurrence in the remnant pancreas.
The presence of FPPA and UPA indicates lateral cancer extension in early-stage pancreatic cancer. Preoperative assessment of the pancreatic parenchyma may provide valuable insights for determining the extent of surgical resection.
局灶性胰腺实质萎缩（FPPA）和上游胰腺萎缩（UPA）可能表明存在早期胰腺癌。在早期胰腺癌中，肿瘤偶尔会沿着主胰管侧向扩散，这给确定手术切除范围带来了挑战。本研究旨在探讨胰腺萎缩模式与胰管内癌扩展的关系。
在五个参与中心接受手术的 32 名早期胰腺癌患者被纳入研究。胰腺萎缩定义为与周围实质相比，胰腺实质变窄，并分为 FPPA（胰管狭窄周围的部分萎缩）或 UPA（胰管狭窄下方的整体萎缩）。胰管内癌扩展定义为扩展超过 10mm。
术前计算机断层扫描显示 FPPA、UPA 和无实质萎缩分别在 13、13 和 6 例患者中发现。有 FPPA 或 UPA 的病例的癌症扩展明显长于无萎缩的病例（P=0.005 和 P=0.03）。除一例 FPPA 病例外，所有病例均存在胰管内癌扩展。69%（9/13）的 UPA 病例存在胰管内癌扩展，而无萎缩的病例则没有胰管内癌扩展。重要的是，两名 FPPA 或 UPA 患者在手术中出现阳性切缘，三名 FPPA 或 UPA 患者在残胰腺中复发。
FPPA 和 UPA 的存在表明早期胰腺癌存在侧向癌扩展。术前评估胰腺实质可能为确定手术切除范围提供有价值的信息。
