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

274 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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