The Incidence of Unnecessary Pancreatic Resections for Non-Cancerous Lesions: A Retrospective Study in a Thai Tertiary Hospital

Jakarin Tantayanondkul; Vor Luvira; Tharatip Srisuk; Vasin Thanasukarn; Kwanchanok Losuwarat; Thitiporn Wannasri; Theerawee Tipwaratorn; Attapol Titapun; Apiwat Jarearnrat; Pathompong Pruekprasert; Suapa Theeragul; Ake Pugkhem; Chawalit Pairojkul; Supot Kamsa-ard

doi:10.31557/apjcc.2024.9.2.277-283

Authors

Jakarin Tantayanondkul Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
Vor Luvira Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
Tharatip Srisuk Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
Vasin Thanasukarn Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
Kwanchanok Losuwarat Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
Thitiporn Wannasri Department of Surgery, Chulabhorn Hospital, Bangkok, Thailand.
Theerawee Tipwaratorn Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
Attapol Titapun Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
Apiwat Jarearnrat Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
Pathompong Pruekprasert Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
Suapa Theeragul Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
Ake Pugkhem Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
Chawalit Pairojkul Department of Pathology, Faculty of Medicine, Khon Kaen University, Thailand.
Supot Kamsa-ard Department of Epidemiology and Biostatistics, Faculty of Public Health, Khon Kaen University, Thailand.

DOI:

https://doi.org/10.31557/apjcc.2024.9.2.277-283

Keywords:

pancreas, cancer, peri-ampullary, mimicking, pancreaticoduodenectomy, pancreatic resection

Abstract

Background: Pancreatic and peri-ampullary cancers are aggressive malignancies requiring surgical intervention. However, certain non-cancerous conditions can mimic these cancers on imaging, leading to unnecessary pancreatic resections. This retrospective study investigated the incidence of non-cancerous lesions removed during pancreatic resections for suspected pancreatic or peri-ampullary cancers in a tertiary hospital in Thailand.

Materials and Methods: This retrospective review was conducted on 148 patients who underwent pancreatic resection between January 2013 and December 2017 at Srinagarind Hospital, Khon Kaen University. Medical and pathological data were analyzed to determine the proportion of patients with non-cancerous lesions.

Results: Nine patients (6.1%) had a postoperative diagnosis of a non-cancerous condition not requiring surgical intervention. The rate of unnecessary resections was significantly higher in patients undergoing distal pancreatectomy or enucleation (15%, 4/27) compared to those undergoing pancreaticoduodenectomy (4.1%, 5/121). While clinical features were similar between patients with cancerous and non-cancerous diagnoses for pancreaticoduodenectomy, a significant difference was observed in gender (p=0.031). No significant clinical differences were found between the two groups after distal pancreatectomy or enucleation.

Conclusion: This study highlights the occurrence of unnecessary pancreatic resections for non-cancerous lesions in a Thai setting. The prevalence of these cases, particularly for distal pancreatectomy and enucleation, suggests the need for careful evaluation and diagnostic strategies to minimize unnecessary surgeries. The findings also highlight potential geographical differences in the types of non-cancerous conditions mimicking pancreatic and peri-ampullary cancers, with Eastern countries experiencing a higher prevalence of ampullary and bile duct conditions compared to Western countries. Further research is needed to develop improved diagnostic tools and refine surgical decision-making processes in this complex clinical setting.