Abstracts
1998 Digestive Disease Week
#1023
PRESUMED MALIGNANT BILIARY OBSTRUCTION DESPITE A NORMAL CT: DATA TO SUPPORT PANCREATICO-DUODENECTOMY (PD). M Bouvet, R Bold, J Lee, P Pisters, J Abbruzzese, I Raijman, C Charnsangavej, DB Evans. The University of Texas M. D. Anderson Cancer Center, Houston, TX.
INTRODUCTION: The absence of a clear mass on CT in patients with suspected periampullary or pancreatic cancer often results in multiple unnecessary attempts at preoperative or intraoperative biopsy and diagnostic confusion on the part of patients and physicians. We, therefore, sought to define clinical, radiologic and endoscopic factors which may distinguish benign from malignant causes of extrahepatic biliary obstruction in patients without a definitive pancreatic mass on high-quality CT.
METHODS: 192 patients underwent PD for biopsy proven or suspected periampullary carcinoma from 1990 to 1997. 34 of these 192 patients had suspected malignant biliary obstruction without an identifiable pancreatic mass on CT. Clinical factors and ERCP findings were correlated with permanent-section histologic diagnosis.
RESULTS: Final pathology was benign in 10 patients and malignant in 24. Seven of 10 (70%) patients who underwent PD for benign disease had either a history of acute pancreatitis or alcohol abuse, or a long biliary stricture (_2.5 cm). These findings were present in only 5 of 24 (21%) patients with malignancy (p=0.006, Chi-squared). 12 of 24 patients with malignancy had an ampullary mass seen endoscopically. The remaining 12 patients with malignancy were compared to the 10 patients with benign disease:
|
|
Benign
(n = 10)
|
Malignant
(n = 12)
|
p
value*
|
|
|
65
|
67
|
NS
|
|
|
7:3
|
6:6
|
NS
|
|
|
3 (30%)
|
1 (8%)
|
0.18
|
|
|
2 (20%)
|
0 (0%)
|
0.10
|
|
|
2 (20%)
|
3 (25%)
|
NS
|
|
|
5 of 6 (83%)
|
1 of 9 (11%)
|
0.09
|
*Chi-squared, **stricture length not available on all patients.
CONCLUSIONS: 12 of 22 patients (55%) had a malignant cause of biliary obstruction despite a normal ampulla and a normal CT. In the absence of a long stricture on ERCP, a benign etiology for biliary obstruction is very unlikely; data critically important for surgeons counseling such patients prior to planned PD.
Copyright 1996 - 1998, SSAT, Inc. Revised 29 June 1998.
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