CEREN CANBEY GORET1, NURI EMRAH GORET2, OMER FARUK OZKAN3, GURAY KILIC4
1Department of Surgical Pathology, Health Sciences University, Sancaktepe Research and Education Hospital, Istanbul, Turkey - 2Department of General Surgery, Health Sciences University, Kartal Research and Education Hospital, Istanbul, Turkey - 3Department of General Surgery, Health Sciences University, Umraniye Research and Education Hospital, Istanbul, Turkey - 4Department Surgical Pathology, Private Ekin Pathology
Objective: Pancreaticoduodenectomy (Whipple) and distal pancreatectomy (DP) operations are the preferred methods for indications ranging from benign inflammatory conditions to malignant neoplasia. Pathological examination of both Whipple and DP materials requires special attention to correctly evaluate many important prognostic factors. In this study, we aimed to present the pathology results of 49 Whipple and DP materials evaluated retrospectively.
Materials and method: Patients were evaluated in the Istanbul Ekin Private Pathology Laboratory between January 2010 and January 2016, operated in Çanakkale Onsekiz Mart University, General Surgery Clinic between January 2016 and August 2017, and Çanakkale State Hospital, General Surgery Clinic between January 2012 and January 2018. A total of 49 Whipple procedure and DP materials, both benign and malignant, were included in the study taking into consideration the age, sex, tumor size, surgical margin status, tumor localization, lymphovascular invasion, perineural invasion, number of lymph nodes, and presence/absence of metastat- ic lymph nodes.
Results: Out of the 49 cases, 12 (24.5%) underwent DP and 37 (75.5%) pancreaticoduodenectomy (Whipple). 27 (55.1%) cases were male and 22 (44.9%) were female, and the mean age was 61.4 years. 8 (16.3%) cases were benign and 41 (83.7%) were malignant. Of the 41 malignant cases, 17 were female and 24 were male; the mean age was 61.4 years. In terms of tumor localiza- tion, 6 (%14.6) tumors were localized to the ampulla, 8 (%19.5) to the pancreas distal, 2 (%4.9) to the duodenum, and 25 (%61) to the pancreas head. In 33 (%80.5) cases, the surgical margin was intact. In 18 (%43.9) cases, metastasis was present.
Conclusion: In pancreatic carcinoma cases that are treated with either Whipple or DP, macroscopy should be assessed patho- logically, and the entire piece should be diligently sampled. By doing so, parameters fundamentally affecting the survey, such as tumor type and lymph node status, will be evaluated more accurately. In addition, rate of resection in benign lesions can be slightly reduced by performing FNAB with ERCP or EUS to the masses detected by imaging in the preoperative period.
Whipple procedure, Distal pancreatectomy, Pancreas pathology, Pancreatitis