Periampullary and pancreatic incidentaloma

A single institution's experience with an increasingly common diagnosis

Jordan M. Winter, John L. Cameron, Keith D. Lillemoe, Kurtis A. Campbell, David Chang, Taylor S. Riall, Joann Coleman, Patricia K. Sauter, Marcia Canto, Ralph H. Hruban, Richard D. Schulick, Michael A. Choti, Charles J. Yeo

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    119 Citations (Scopus)

    Abstract

    BACKGROUND: While incidental masses in certain organs have received particular attention, periampullary and pancreatic incidentalomas (PIs) remain poorly characterized. METHODS: We reviewed 1944 consecutive pancreaticoduodenectomies (PD) over an 8-year period (April 1997 to October 2005). A total of 118 patients (6% of all PDs) presented with an incidental finding of a periampullary or pancreatic mass. The PI patients were analyzed and compared with the rest of the cohort (NI, nonincidentaloma group, n = 1826). RESULTS: Thirty-one percent of the PI patients (n = 37) had malignant disease (versus 76% of the NI patients, P < 0.001), 47% (n = 55) had premalignant disease, and the remaining 22% (n = 26) had little or no risk for malignant progression. The 3 most common diagnoses in the PI group were IPMN without invasive cancer (30%), cystadenoma (17%), and pancreatic ductal adenocarcinoma (10%). The PI group had a higher overall complication rate (55% versus 43%, P = 0.02), due in part to a significantly increased rate of pancreatic fistulas (18.4% PI versus 8.5% NI, P < 0.001). Patients in the PI group with malignant disease had a superior long-term survival (median, 30 months, P = 0.01) compared with patients in the NI group with malignant disease (median, 21 months). CONCLUSIONS: Incidentally discovered periampullary and pancreatic masses comprise a substantial proportion of patients undergoing PD. Roughly three fourths of these lesions are malignant or premalignant, and amenable to curative resection. Resected malignant PIs have favorable pathologic features as compared with resected malignant NIs, and resection of these early lesions in asymptomatic individuals is associated with improved survival, compared with patients with symptomatic disease.

    Original languageEnglish (US)
    Pages (from-to)673-680
    Number of pages8
    JournalAnnals of Surgery
    Volume243
    Issue number5
    DOIs
    StatePublished - May 2006

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    Pancreaticoduodenectomy
    Cystadenoma
    Pancreatic Fistula
    Incidental Findings
    Survival
    Adenocarcinoma
    Neoplasms

    ASJC Scopus subject areas

    • Surgery

    Cite this

    Winter, J. M., Cameron, J. L., Lillemoe, K. D., Campbell, K. A., Chang, D., Riall, T. S., ... Yeo, C. J. (2006). Periampullary and pancreatic incidentaloma: A single institution's experience with an increasingly common diagnosis. Annals of Surgery, 243(5), 673-680. https://doi.org/10.1097/01.sla.0000216763.27673.97

    Periampullary and pancreatic incidentaloma : A single institution's experience with an increasingly common diagnosis. / Winter, Jordan M.; Cameron, John L.; Lillemoe, Keith D.; Campbell, Kurtis A.; Chang, David; Riall, Taylor S.; Coleman, Joann; Sauter, Patricia K.; Canto, Marcia; Hruban, Ralph H.; Schulick, Richard D.; Choti, Michael A.; Yeo, Charles J.

    In: Annals of Surgery, Vol. 243, No. 5, 05.2006, p. 673-680.

    Research output: Contribution to journalArticle

    Winter, JM, Cameron, JL, Lillemoe, KD, Campbell, KA, Chang, D, Riall, TS, Coleman, J, Sauter, PK, Canto, M, Hruban, RH, Schulick, RD, Choti, MA & Yeo, CJ 2006, 'Periampullary and pancreatic incidentaloma: A single institution's experience with an increasingly common diagnosis', Annals of Surgery, vol. 243, no. 5, pp. 673-680. https://doi.org/10.1097/01.sla.0000216763.27673.97
    Winter, Jordan M. ; Cameron, John L. ; Lillemoe, Keith D. ; Campbell, Kurtis A. ; Chang, David ; Riall, Taylor S. ; Coleman, Joann ; Sauter, Patricia K. ; Canto, Marcia ; Hruban, Ralph H. ; Schulick, Richard D. ; Choti, Michael A. ; Yeo, Charles J. / Periampullary and pancreatic incidentaloma : A single institution's experience with an increasingly common diagnosis. In: Annals of Surgery. 2006 ; Vol. 243, No. 5. pp. 673-680.
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    abstract = "BACKGROUND: While incidental masses in certain organs have received particular attention, periampullary and pancreatic incidentalomas (PIs) remain poorly characterized. METHODS: We reviewed 1944 consecutive pancreaticoduodenectomies (PD) over an 8-year period (April 1997 to October 2005). A total of 118 patients (6{\%} of all PDs) presented with an incidental finding of a periampullary or pancreatic mass. The PI patients were analyzed and compared with the rest of the cohort (NI, nonincidentaloma group, n = 1826). RESULTS: Thirty-one percent of the PI patients (n = 37) had malignant disease (versus 76{\%} of the NI patients, P < 0.001), 47{\%} (n = 55) had premalignant disease, and the remaining 22{\%} (n = 26) had little or no risk for malignant progression. The 3 most common diagnoses in the PI group were IPMN without invasive cancer (30{\%}), cystadenoma (17{\%}), and pancreatic ductal adenocarcinoma (10{\%}). The PI group had a higher overall complication rate (55{\%} versus 43{\%}, P = 0.02), due in part to a significantly increased rate of pancreatic fistulas (18.4{\%} PI versus 8.5{\%} NI, P < 0.001). Patients in the PI group with malignant disease had a superior long-term survival (median, 30 months, P = 0.01) compared with patients in the NI group with malignant disease (median, 21 months). CONCLUSIONS: Incidentally discovered periampullary and pancreatic masses comprise a substantial proportion of patients undergoing PD. Roughly three fourths of these lesions are malignant or premalignant, and amenable to curative resection. Resected malignant PIs have favorable pathologic features as compared with resected malignant NIs, and resection of these early lesions in asymptomatic individuals is associated with improved survival, compared with patients with symptomatic disease.",
    author = "Winter, {Jordan M.} and Cameron, {John L.} and Lillemoe, {Keith D.} and Campbell, {Kurtis A.} and David Chang and Riall, {Taylor S.} and Joann Coleman and Sauter, {Patricia K.} and Marcia Canto and Hruban, {Ralph H.} and Schulick, {Richard D.} and Choti, {Michael A.} and Yeo, {Charles J.}",
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    T1 - Periampullary and pancreatic incidentaloma

    T2 - A single institution's experience with an increasingly common diagnosis

    AU - Winter, Jordan M.

    AU - Cameron, John L.

    AU - Lillemoe, Keith D.

    AU - Campbell, Kurtis A.

    AU - Chang, David

    AU - Riall, Taylor S.

    AU - Coleman, Joann

    AU - Sauter, Patricia K.

    AU - Canto, Marcia

    AU - Hruban, Ralph H.

    AU - Schulick, Richard D.

    AU - Choti, Michael A.

    AU - Yeo, Charles J.

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    N2 - BACKGROUND: While incidental masses in certain organs have received particular attention, periampullary and pancreatic incidentalomas (PIs) remain poorly characterized. METHODS: We reviewed 1944 consecutive pancreaticoduodenectomies (PD) over an 8-year period (April 1997 to October 2005). A total of 118 patients (6% of all PDs) presented with an incidental finding of a periampullary or pancreatic mass. The PI patients were analyzed and compared with the rest of the cohort (NI, nonincidentaloma group, n = 1826). RESULTS: Thirty-one percent of the PI patients (n = 37) had malignant disease (versus 76% of the NI patients, P < 0.001), 47% (n = 55) had premalignant disease, and the remaining 22% (n = 26) had little or no risk for malignant progression. The 3 most common diagnoses in the PI group were IPMN without invasive cancer (30%), cystadenoma (17%), and pancreatic ductal adenocarcinoma (10%). The PI group had a higher overall complication rate (55% versus 43%, P = 0.02), due in part to a significantly increased rate of pancreatic fistulas (18.4% PI versus 8.5% NI, P < 0.001). Patients in the PI group with malignant disease had a superior long-term survival (median, 30 months, P = 0.01) compared with patients in the NI group with malignant disease (median, 21 months). CONCLUSIONS: Incidentally discovered periampullary and pancreatic masses comprise a substantial proportion of patients undergoing PD. Roughly three fourths of these lesions are malignant or premalignant, and amenable to curative resection. Resected malignant PIs have favorable pathologic features as compared with resected malignant NIs, and resection of these early lesions in asymptomatic individuals is associated with improved survival, compared with patients with symptomatic disease.

    AB - BACKGROUND: While incidental masses in certain organs have received particular attention, periampullary and pancreatic incidentalomas (PIs) remain poorly characterized. METHODS: We reviewed 1944 consecutive pancreaticoduodenectomies (PD) over an 8-year period (April 1997 to October 2005). A total of 118 patients (6% of all PDs) presented with an incidental finding of a periampullary or pancreatic mass. The PI patients were analyzed and compared with the rest of the cohort (NI, nonincidentaloma group, n = 1826). RESULTS: Thirty-one percent of the PI patients (n = 37) had malignant disease (versus 76% of the NI patients, P < 0.001), 47% (n = 55) had premalignant disease, and the remaining 22% (n = 26) had little or no risk for malignant progression. The 3 most common diagnoses in the PI group were IPMN without invasive cancer (30%), cystadenoma (17%), and pancreatic ductal adenocarcinoma (10%). The PI group had a higher overall complication rate (55% versus 43%, P = 0.02), due in part to a significantly increased rate of pancreatic fistulas (18.4% PI versus 8.5% NI, P < 0.001). Patients in the PI group with malignant disease had a superior long-term survival (median, 30 months, P = 0.01) compared with patients in the NI group with malignant disease (median, 21 months). CONCLUSIONS: Incidentally discovered periampullary and pancreatic masses comprise a substantial proportion of patients undergoing PD. Roughly three fourths of these lesions are malignant or premalignant, and amenable to curative resection. Resected malignant PIs have favorable pathologic features as compared with resected malignant NIs, and resection of these early lesions in asymptomatic individuals is associated with improved survival, compared with patients with symptomatic disease.

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