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

276 Citations (Scopus)

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
Externally publishedYes

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Pancreaticoduodenectomy
Chronic Pancreatitis
Biliary Tract Diseases
Pancreatitis
Neoplasms
Pancreas
Choledocholithiasis
Pancreatic Diseases
Sclerosing Cholangitis
Common Bile Duct
Gallstones
Pathologic Constriction
Adenocarcinoma
Alcohols

Keywords

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

ASJC Scopus subject areas

  • Anatomy
  • Pathology and Forensic Medicine

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

Pancreaticoduodenectomy (Whipple resections) in patients without malignancy : Are they all 'chronic pancreatitis'? / Abraham, Susan C.; Wilentz, Robb E.; Yeo, Charles J.; Sohn, Taylor A.; Cameron, John L.; Boitnott, John K.; Hruban, Ralph H.

In: American Journal of Surgical Pathology, Vol. 27, No. 1, 01.01.2003, p. 110-120.

Research output: Contribution to journalArticle

Abraham, Susan C. ; Wilentz, Robb E. ; Yeo, Charles J. ; Sohn, Taylor A. ; Cameron, John L. ; Boitnott, John K. ; Hruban, Ralph H. / Pancreaticoduodenectomy (Whipple resections) in patients without malignancy : Are they all 'chronic pancreatitis'?. In: American Journal of Surgical Pathology. 2003 ; Vol. 27, No. 1. pp. 110-120.
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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.",
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