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Preoperative Characteristics of Patients with Presumed Pancreatic Cancer but Ultimately Benign Disease: A Multicenter Series of 344 Pancreatoduodenectomies

  • Pancreatic Tumors
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Abstract

Background

Preoperative differentiation between malignant and benign pancreatic tumors can be difficult. Consequently, a proportion of patients undergoing pancreatoduodenectomy for suspected malignancy will ultimately have benign disease. The aim of this study was to compare preoperative clinical and diagnostic characteristics of patients with unexpected benign disease after pancreatoduodenectomy with those of patients with confirmed (pre)malignant disease.

Methods

We performed a multicenter retrospective cohort study in 1,629 consecutive patients undergoing pancreatoduodenectomy for suspected malignancy between 2003 and 2010 in 11 Dutch centers. Preoperative characteristics were compared in a benign:malignant ratio of 1:3. Malignant cases were selected from the entire cohort by using a random number list. A multivariable logistic regression prediction model was constructed to predict benign disease.

Results

Of 107 patients (6.6 %) with unexpected benign disease after pancreatoduodenectomy, 86 fulfilled the inclusion criteria and were compared with 258 patients with (pre)malignant disease. Patients with benign disease presented more often with pain (56 vs. 38 %; P = 0.004), but less frequently with jaundice (60 vs. 80 %; P < 0.01), a pancreatic mass (13 vs. 54 %, P < 0.001), or a double duct sign on computed tomography (21 vs. 47 %; P < 0.001). In a prediction model using these parameters, only 19 % of patients with benign disease were correctly predicted, and 1.4 % of patients with malignant disease were missed.

Conclusions

Nearly 7 % of patients undergoing pancreatoduodenectomy for suspected malignancy were ultimately diagnosed with benign disease. Although some preoperative clinical and imaging characteristics might indicate absence of malignancy, their discriminatory value is insufficient for clinical use.

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Conflicts of interest and Source of Funding

A. G. received an unrestricted grant from IPSEN Pharmaceuticals NL B.V. For the remaining authors, none was declared.

Author information

Authors and Affiliations

  1. Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands

    Arja Gerritsen MD, I. Quintus Molenaar MD, PhD, Hjalmar C. van Santvoort MD, PhD & Inne H. M. Borel Rinkes MD, PhD

  2. Department of Surgery, Academic Medical Center Amsterdam, Amsterdam, The Netherlands

    Arja Gerritsen MD, Dirk J. Gouma MD, PhD, Olivier R. C. Busch MD, PhD & Marc G. Besselink MD, MSc, PhD

  3. Department of Radiology, St. Antonius Hospital Nieuwegein, Nieuwegein, The Netherlands

    Thomas L. Bollen MD

  4. Department of Radiology, Academic Medical Center Amsterdam, Amsterdam, The Netherlands

    C. Yung Nio MD

  5. Clinical Research Unit, Academic Medical Center Amsterdam, Amsterdam, The Netherlands

    Marcel G. Dijkgraaf PhD

  6. Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands

    G. Johan Offerhaus MD, PhD

  7. Department of Pathology, Academic Medical Center Amsterdam, Amsterdam, The Netherlands

    Lodewijk A. Brosens MD, PhD

  8. Department of Pathology, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands

    Katharina Biermann MD, PhD

  9. Department of Surgery, University Medical Center Groningen, Groningen, The Netherlands

    Egbert Sieders MD, PhD & Koert P. de Jong MD, PhD

  10. Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands

    Ronald M. van Dam MD, PhD

  11. Department of Surgery, Maasstad Hospital Rotterdam, Rotterdam, The Netherlands

    Erwin van der Harst MD, PhD

  12. Department of Surgery, Radboud University Medical Centre Nijmegen, Nijmegen, The Netherlands

    Harry van Goor MD, PhD

  13. Department of Surgery, St. Antonius Hospital Nieuwegein, Nieuwegein, The Netherlands

    Bert van Ramshorst MD, PhD

  14. Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands

    Bert A. Bonsing MD, PhD

  15. Department of Surgery, Catharina Hospital Eindhoven, Eindhoven, The Netherlands

    Ignace H. de Hingh MD, PhD

  16. Department of Surgery, OLVG Amsterdam, Amsterdam, The Netherlands

    Michael F. Gerhards MD, PhD

  17. Department of Surgery, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands

    Casper H. van Eijck MD, PhD

Authors
  1. Arja Gerritsen MD
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  2. I. Quintus Molenaar MD, PhD
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  3. Thomas L. Bollen MD
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  5. Marcel G. Dijkgraaf PhD
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  10. Egbert Sieders MD, PhD
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  11. Koert P. de Jong MD, PhD
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  12. Ronald M. van Dam MD, PhD
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  13. Erwin van der Harst MD, PhD
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  14. Harry van Goor MD, PhD
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  15. Bert van Ramshorst MD, PhD
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  16. Bert A. Bonsing MD, PhD
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  17. Ignace H. de Hingh MD, PhD
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  18. Michael F. Gerhards MD, PhD
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  19. Casper H. van Eijck MD, PhD
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  20. Dirk J. Gouma MD, PhD
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  21. Inne H. M. Borel Rinkes MD, PhD
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  22. Olivier R. C. Busch MD, PhD
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  23. Marc G. Besselink MD, MSc, PhD
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Consortia

Dutch Pancreatic Cancer Group

Corresponding author

Correspondence to Marc G. Besselink MD, MSc, PhD.

Appendix

Appendix

See Appendix Table 6.

Table 6 Diagnostic value of the presence of pain and absence of jaundice, mass, and double duct sign on CT for the prediction of benign disease
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Gerritsen, A., Molenaar, I.Q., Bollen, T.L. et al. Preoperative Characteristics of Patients with Presumed Pancreatic Cancer but Ultimately Benign Disease: A Multicenter Series of 344 Pancreatoduodenectomies. Ann Surg Oncol 21, 3999–4006 (2014). https://doi.org/10.1245/s10434-014-3810-7

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  • DOI: https://doi.org/10.1245/s10434-014-3810-7

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