Pancreaticoduodenectomy for benign disease

Abstract

Background: Pancreaticoduodenectomy (PD) has now become the standard treatment for malignant and benign peri-ampullary pathologies. PD for benign pathologies rates varies between 5-13% in the literature. The aim of this study was to evaluate the incidence of patients with benign disease with PD applied histopathologically and to review our clinical experience in view of the literature. Method: All patients who underwent PD between 2010 and 2017 were included in the study. The incidence, demographic characteristics, morbidity and mortality of the patients with histopathologically diagnosed as benign disease were evaluated. Results: A total of 283 pancreaticoduodenectomies had been performed during the study period. In 20 (7%) of these patients, benign disease was detected in postoperative histopathological evaluation. The mean age of the patients was 55.8 years. In 20 patients with benign disease, 8 patients underwent endoscopic ultrasound fine needle aspiration (EUS-FNA) and 10 endoscopic brush biopsy. EUS-FNA and endoscopic brush biopsy were not performed in 2 patients. The distribution of histopathological diagnosis of patients after PD was chronic pancreatitis in 7 patients, pancreatic intraepithelial neoplasia in 4 patients, tubular villous adenoma in 3 patients, mucinous cystic neoplasia in 3 patients, biliary intraepithelial neoplasia in 1 patient, dysplasia in 1 patient and benign cyst in 1 patient. Conclusion: Because of delays related to diagnosis and treatment for periampullary tumors lead to short survival generally stressed out the surgeons and gastroenterologists, and tent to behave more meticulous during the diagnosis and treatment. There is a tendency to be performed PD in the association of unclear mass and jaundice. PD will continue to be performed due to many benign pathologies in the future. However, more effective use of diagnostic Methods and multimodal approach will be able to reduce this rate.