Pancreaticoduodenectomy for suspected malignancy: have advancements in radiographic imaging improved results?

Background: The purpose of this study was to determine the impact of recent improvements in radiographic imaging in detecting malignant pancreatic disease.

Methods: A review of 132 patients undergoing pancreaticoduodenectomy for suspected malignancy from 1998 to 2005 was performed. Since 1998, patients were evaluated with helical computed tomography and since 2002 with multidetection scanners.

Results: Seventeen patients (12.9%) had nonneoplastic disease. The majority of these patients had chronic fibrosing pancreatitis (11 patients) and sclerosing lymphoplasmacytic pancreatitis (4 patients). The incidence of benign disease in patients undergoing resection from 1998 to 2001 (n = 45) was 8.9% in comparison to 14.9% for patients treated from 2002 to 2005 (n = 87, P = .39).

Conclusion: Advances in imaging modalities made during the study period did not improve our ability to discriminate between benign inflammatory conditions and neoplastic disease. The inability to distinguish benign from neoplastic disease justifies the use of pancreaticoduodenectomy in the appropriate clinical setting.