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Medline ® Abstract for Reference 161

of 'Clinical manifestations, diagnosis, and staging of exocrine pancreatic cancer'

161
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Incidence of benign disease in patients that underwent resection for presumed pancreatic cancer diagnosed by endoscopic ultrasonography (EUS) and fine-needle aspiration (FNA).
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de la Fuente SG, Ceppa EP, Reddy SK, Clary BM, Tyler DS, Pappas TN
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J Gastrointest Surg. 2010 Jul;14(7):1139-42. Epub 2010 Apr 28.
 
INTRODUCTION: The lack of accurate markers makes preoperative differentiation between pancreatic cancer and non-malignant head lesions clinically challenging. In this study, we investigated the incidence of benign disease in patients that underwent resection for presumed pancreatic cancer diagnosed by EUS and EUS-guided FNA.
METHODS: Medical records of consecutive patients who underwent pancreaticoduodenectomy at Duke University were reviewed. Demographics, clinicopathologic characteristics, preoperative imaging, EUS, EUS-guided FNA, and postoperative outcomes were analyzed.
RESULTS: Seven percent of the total 494 patients studied were found to have benign disease on postoperative pathology. Fifty-nine percent of these patients with benign disease underwent preoperative EUS. EUS was positive for a head mass in 70%, demonstrated enlarged lymph nodes in 27%, and showed signs concerning for vascular invasion in 13%. FNA was suspicious or indeterminate for cancer in 63% of patients. Postoperative complications occurred in 47% and one patient died after surgery. The overall pancreatic leak rate was 15%.
CONCLUSIONS: Even with aggressive use of preoperative evaluation, there is still a small subset of patients where malignancy cannot be excluded without pancreaticoduodenectomy.
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Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA. delaf002@mc.duke.edu
PMID