Increased Incidence of Benign Pancreatic Pathology following Pancreaticoduodenectomy for Presumed Malignancy over 10 Years despite Increased Use of Endoscopic Ultrasound

Abstract

Despite using imaging studies, tissue sampling, and serologic tests about 5-10% of surgeries done for presumed pancreatic malignancies will have benign findings on final pathology. Endoscopic ultrasound (EUS) is used with increasing frequency to study pancreatic masses. The aim of this study is to examine the effect of EUS on prevalence of benign diseases undergoing Whipple over the last decade. Patients who underwent Whipple procedure for presumed malignancy at Emory University Hospital from 1998 to 2011 were selected. Demographic data, history of smoking and drinking, history of diabetes and pancreatitis, imaging data, pathology reports, and tumor markers were extracted. 878 patients were found. 95 (10.82%) patients had benign disease. Prevalence of benign finding had increased over the recent years despite using more EUS. Logistic regression models showed that abdominal pain (OR: 5.829, 95% CI 2.681-12.674, P ≤ 0.001) and alcohol abuse (OR: 3.221, CI 95%: 1.362-7.261, P: 0.002) were predictors of benign diseases. Jaundice (OR: 0.221, 95% CI: 0.084-0.58, P: 0.002), mass (OR: 0.145, 95% CI: 0.043-0.485, P: 0.008), and ductal dilation (OR: 0.297, 95% CI 0.134-0.657, P: 0.003) were associated with malignancy. Use of imaging studies, ERCP, and EUS has not decreased the percentage of benign findings after surgery for presumed pancreatic malignancy.

Figure 1

Distribution of number of surgeries and percentage of benign pathologic findings per year. Number of Whipple surgeries performed each year for presumed malignant disease at EUH from 1998 to 2011. Number and percentage of benign findings are listed above each bar. As illustrated in the figure, total number of surgeries and percentage of benign findings have been increased over the years.

Figure 2

Number of EUS/FNA performed between 1998 and 2011 in patients with benign disease who underwent Whipple procedure for presumed malignancy. Number of EUS/FNA in patients with benign findings after Whipple procedure performed each year for presumed malignant disease at EUH from 1998 to 2011. As illustrated, number of EUS/FNA performed has increased over the years, but has not led to decreased number of Whipple procedures performed for benign diseases.