Evaluation & management of clinically labeled carcinoma head of the pancreas--a prospective study of 60 patients.

ABSTRACT

Carcinoma head of the pancreas are assessed by clinical examination, imaging, Endoscopic Retrograde Cholangio Pancreatography (ERCP), Fine Needle Aspiration Cytology (FNAC) and finally by laparotomy. Nevertheless still there is a dilemma in labeling these patients as having inoperable cancer pancreas because operable lesions may be wrongly labeled as inoperable or benign lesion may be thought to be malignant. The aim of this study is to evaluate these patients who present with clinical features of inoperable carcinoma of pancreas and to assess their status of inoperability. Efforts were taken to explore the possibilities of curative resection. If found inoperable, then tissue or cytological sampling of the lesion and the alternative palliation therapy offered to them. Palliative surgery and respective analysis of data was done in 60 patients with clinically labeled carcinoma head of the pancreas. Laparotomy was done for--(i) Assessment of inoperability, (ii) tissue or cytological sampling and (iii) Bilioenteric and gastro enteric bypass. The tumor was considered to be inoperable by peroperative assessment & trial dissection when it invaded the surrounding vital structure. Histological confirmation was made by intraoperative core needle biopsy; shave biopsy, biopsy of hepatic and lymph node metastasis. Cytological sampling was done by transduodenal and intralesional FNAC. Hepaticojejunostomy or Cholecystojejunostomy, Gastrojejunostomy and enteroenterostomy were performed as palliative procedure in all patients. Chemical splanchinectomy was performed in 25 patients. Twenty patients were diagnosed to have carcinoma by Endoscopic biopsy. In remaining 40 patients, peroperative tissue biopsy and cytological sampling yielded pancreatic carcinoma in 16 (40.0%), chronic pancreatitis in 6 (15.0%), pancreatic tuberculosis in 5 (12.5%), pancreatic non Hodgkin's lymphoma in 3 (7.5%) and metastatic pancreatic cancer in 2 (5.0%). However, it failed to reveal any definitive diagnosis in 8 (20.0%) patients. These interesting findings changed the preoperative diagnosis and guided us to plan the surgical procedure for cancerous and non-cancerous patients accordingly.