Pancreaticoduodenectomy (Whipple resections) in patients without malignancy: Are they all 'chronic pancreatitis'?

Susan C. Abraham, Robb E. Wilentz, Charles J. Yeo, Taylor A. Sohn, John L. Cameron, John K. Boitnott, Ralph H. Hruban

    Research output: Contribution to journalArticle

    280 Scopus citations

    Abstract

    Pancreaticoduodenectomy (Whipple resection) has evolved into a safe procedure in major high-volume medical centers for the treatment of pancreatic adenocarcinoma and refractory chronic pancreatitis. However, some Whipple resections performed for a clinical suspicion of malignancy reveal only benign disease on pathologic examination. We evaluated the frequency of such Whipple resections without tumor in a large series of pancreaticoduodenectomies and classified the diverse pancreatic and biliary tract diseases present in these specimens. Of 442 Whipple resections performed during 1999-2001, 47 (10.6%) were negative for neoplastic disease and, in 40 cases, had been performed for a clinical suspicion of malignancy. Most Whipple resections revealed benign pancreatic disease, including 8 (17%) alcohol-associated chronic pancreatitis, 4 (8.5%) gallstone-associated pancreatitis, 1 (2.1%) pancreas divisum, 6 (12.8%) "ordinary" chronic pancreatitis of unknown etiology, and 11 (23.4%). lymphoplasmacytic sclerosing pancreatitis. In particular, patients with lymphoplasmacytic sclerosing pancreatitis were all thought to harbor malignancy, whereas only 13 of 19 (68.4%) of Whipple resections showing histologically "ordinary" forms of chronic pancreatitis were performed for a clinical suspicion of malignancy. Benign biliary tract disease, including three cases of primary sclerosing cholangitis, two cases of choledocholithiasis-associated chronic biliary tract disease, and four fibroinflammatory strictures isolated to the intrapancreatic common bile duct, was a common etiology for clinically suspicious Whipple resections (22.5% of cases). Pancreatic intraepithelial neoplasia (PanIN) was a common finding among all pancreata, whether involved by pancreatitis or histologically normal. Overall, PanIN 1A/1B was present in 68.1%, PanIN 2 in 40.4%, and PanIN 3 in just 2.1%. These findings indicate that "benign but clinically suspicious" Whipple resections are relatively common in high-volume centers (9.2%) and reveal a diverse group of clinicopathologically distinctive pancreatic and biliary tract disease.

    Original languageEnglish (US)
    Pages (from-to)110-120
    Number of pages11
    JournalAmerican Journal of Surgical Pathology
    Volume27
    Issue number1
    DOIs
    StatePublished - Jan 1 2003

    Keywords

    • Chronic pancreatitis
    • Pancreas
    • Pancreaticoduodenectomy
    • Sclerosing cholangitis
    • Sclerosing pancreatitis
    • Whipple

    ASJC Scopus subject areas

    • Anatomy
    • Surgery
    • Pathology and Forensic Medicine

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  • Cite this

    Abraham, S. C., Wilentz, R. E., Yeo, C. J., Sohn, T. A., Cameron, J. L., Boitnott, J. K., & Hruban, R. H. (2003). Pancreaticoduodenectomy (Whipple resections) in patients without malignancy: Are they all 'chronic pancreatitis'? American Journal of Surgical Pathology, 27(1), 110-120. https://doi.org/10.1097/00000478-200301000-00012