Is pancreaticoduodenectomy justified for chronic pancreatitis masquerading as periampullary tumor?

Chronic pancreatitis associated with periampullary mass often presents diagnostic and therapeutic dilemmas. Incidence and justification of pancraticoduodenectomy for chronic pancreatitis masquerading as pancreatic head cancer and sensitivity of frozen-section biopsy in detecting the periampullary malignancy were investigated.

Nine patients with chronic pancreatitis masquerading as periampullary tumor were included to study the clinical features, clinical diagnostic rates, and surgical risk. Pathological data of 272 periampullary malignancies were analyzed to evaluate the diagnostic rate of preoperative endoscopic biopsy and the reliability of intraoperative frozen-section biopsy.

The incidence of pancreaticoduodenectomy for chronic pancreatitis masquerading as periampullary tumor was 3.2%. The most common symptoms for these 9 chronic pancreatitis patients were epigastric pain (88.9%), jaundice (55.6%) and body weight loss (55.6%), with a median duration of symptom of 9 months. All of these chronic pancreatitis lesions in the periampullary region were considered to be pancreatic head or periampullary cancer by image studies except 1 to be chronic pancreatitis by ultrasound and endoscopic retrograde cholangiopancreatography. No surgical mortality and only 1 minor complication with wound infection occurred. Among the 272 periampullary malignancies, the positive diagnostic rate by preoperative endoscopic biopsy was 26.5%. The overall sensitivity of frozen-section biopsy in detecting the periampullary malignancy was 70.7%.

Pancreaticoduodenectomy may be justified for chronic pancreatitis presenting as periampullary mass, in terms of nonspecific clinical features, unreliable preoperative imaging studies, undependable intraoperative frozen-section biopsy and low surgical risk.