Results of pancreaticoduodenectomy for lymphoplasmacytic sclerosing pancreatitis.

Authors

• Jeffrey M Hardacre
• Christine A Iacobuzio-Donahue
• Taylor A Sohn
• Susan C Abraham
• Charles J Yeo
• Keith D Lillemoe
• Michael A Choti
• Kurtis A Campbell
• Richard D Schulick
• Ralph H Hruban
• John L Cameron
• Steven D Leach

Publication/Presentation Date

6-1-2003

Abstract

OBJECTIVE: To compare the presentation and short-term results of pancreaticoduodenectomy for lymphoplasmacytic sclerosing pancreatitis (LPSP) and pancreatic adenocarcinoma (PA) and to provide long-term follow-up on patients undergoing resection for LPSP.

SUMMARY BACKGROUND DATA: LPSP is a rare form of chronic pancreatitis characterized by a mixed inflammatory infiltrate centered around pancreatic ducts and ductules, combined with obliterative phlebitis. Its presentation may mimic that of PA.

METHODS: Among 1,648 patients undergoing pancreaticoduodenectomy at the authors' institution from January 1992 to May 2002, 37 with LPSP were identified. The demographics, clinical features, and short- and long-term outcomes of these patients were analyzed. Where applicable, comparisons were made to a consecutive group of 45 patients who underwent pancreaticoduodenectomy for PA from July 2001 to December 2001.

RESULTS: Twenty-four percent (9/37) of the LPSP patients and none of the PA patients had a history of either atopic or autoimmune disease. The LPSP patients had a similar clinical presentation to the PA patients, but the LPSP patients were less likely to have a discrete pancreatic mass on CT and more likely to have CT findings suggesting a diffusely enlarged pancreas. The LPSP patients were also less likely to have a discrete pancreatic mass at operation, more likely to have a diffusely firm or hard gland, and more likely to have a difficult portal vein/superior mesenteric vein dissection when compared to the PA patients. Transfusion requirement, operative time, postoperative length of stay, and overall complication rate were similar between groups; however, the LPSP patients had a greater operative blood loss. The median length of follow-up for LPSP patients was 33 months. No patients had recurrent jaundice. One patient with LPSP had clinically evident recurrent pancreatitis. Among LPSP patients available for current telephone interview, 68% subjectively rated their quality of life as better, 18% reported no change, and 14% reported diminished quality of life compared to before surgery.

CONCLUSION: LPSP mimics PA in clinical presentation, though CT findings of a diffusely enlarged pancreas without a discrete mass may suggest a diagnosis of LPSP. Nevertheless, differentiation from pancreatic neoplasia remains difficult. Patients undergoing pancreaticoduodenectomy for LPSP have durable relief of symptoms and a subjectively improved quality of life.

Volume

237

Issue

6

First Page

853

Last Page

858

ISSN

0003-4932

Published In/Presented At

Hardacre, J. M., Iacobuzio-Donahue, C. A., Sohn, T. A., Abraham, S. C., Yeo, C. J., Lillemoe, K. D., Choti, M. A., Campbell, K. A., Schulick, R. D., Hruban, R. H., Cameron, J. L., & Leach, S. D. (2003). Results of pancreaticoduodenectomy for lymphoplasmacytic sclerosing pancreatitis. Annals of surgery, 237(6), 853–859. https://doi.org/10.1097/01.SLA.0000071516.54864.C1

Disciplines

Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods

PubMedID

12796582

Department(s)

Administration and Leadership

Document Type

Article