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Lookup NU author(s): Richard Charnley
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Background. Pancreatoduodenectomy (PD) provides the best chance for cure in the treatment of patients with localized pancreatic head cancer. In patients with a suspected, clinically resectable pancreatic head malignancy, the need for histologic confirmation before proceeding with PD has not historically been required, but remains controversial.Methods. An international panel of pancreatic surgeons working in well-known, high-volume centers reviewed the literature and worked together to establish a consensus on when to perform a PD in the absence of positive histology.Results. The incidence of benign disease after PD for a presumed malignancy is 5-13%. Diagnosis by endoscopic cholangiapancreatography brushings and percutaneous fine-needle aspiration are highly specific, but poorly sensitive. Aspiration biopsy guided by enclascopic ultrasonography (EUS) has greater sensitivity, but it is highly operator dependent and increases expense. The incidence of autoimmune pancreatitis (AlP) in the benign resected specimens is 30-43%. EUS-guided Trucut biopsy, serum levels of immunoglobulin G4, and HISORt (Histology, Imaging, Serology, Other organ involvement, and Response to therapy) are used for diagnosis. If AIP is suspected but not confirmed, the response to a short course of steroids is helpful for diagnosis.Conclusion. In the presence of a solid mass suspicious formalignancy, consensus was reached that biopsy proof is not required before proceeding with resection. Confirmation of malignancy, however, is mandatory for patients with borderline. resectable disease to be treated with neoadjuvant therapy before exploration for resection. When a diagnosis of AIP is highly suspected, a biopsy is recommended, and a short course of steroid treatment should be considered if the biopsy does not reveal features suspicious for malignancy.
Author(s): Asbun HJ, Conlon K, Fernandez-Cruz L, Riess H, Shrikhande SV, Adham M, Bassi C, Bockhorn M, Buchler M, Charnley RM, Dervenis C, Fingerhutt A, Gouma DJ, Hartwig W, Imrie C, Izbicki JR, Lillemoe KD, Milicevic M, Montorsi M, Neoptolemos JP, Sandberg AA, Sarr M, Vollmer C, Yeo CJ, Traverso LW, Int Study Grp Pancreatic Surg
Publication type: Article
Publication status: Published
Journal: Surgery
Year: 2014
Volume: 155
Issue: 5
Pages: 887-892
Print publication date: 01/05/2014
ISSN (print): 0039-6060
ISSN (electronic): 1532-7361
Publisher: Mosby, Inc.
URL: http://dx.doi.org/10.1016/j.surg.2013.12.032
DOI: 10.1016/j.surg.2013.12.032
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