Abstract
The size of a pancreatic ductal carcinoma is one of the factors that has the greatest impact on the prognosis of the disease. Precise measurement of tumor size in such cases can obviously be achieved only by the pathologist, but, as a result of the increasingly widespread use and refinement of imaging procedures, a fairly accurate preoperative estimate now appears feasible for identifying those lesions which measure ≤2 m in size and which are conventionally defined as “small tumors.” At tomography, 15/72 patients (20.8%) with cancer of the head of the pancreas observed in our department over the period 1991 to 1994 were prospectively identified as having tumors measuring ≤2 cm. Histology subsequently confirmed that the growths measured 2 cm or less in size in only 4 of these patients, thus revealing that the imaging technique tended to underestimate the tumor diameters. If we exclude the mean time elapsing from onset of symptoms to diagnosis, which was found to be significantly shorter in small than in non-small tumors (6.3 vs 34.2 days,P <0.01), no statistically significant differences were observed in any of the clinical and blood chemistry data evaluated (including CA 19-9 values) in patients with small vs non-small tumors who underwent radical resection. Small tumors of the pancreas are still rare and their diagnosis is often incidental (2/4 in this case series) and can only be confirmed by pathology findings. The radiological detection of a small tumor, however, is strongly suggestive of resectability (more than 70% in this series). This should prompt the surgeon to adopt an aggressive approach, even though the topographical location and biological nature of tumors measuring ≤2 cm are known to be capable of substantially undermining their potentially better prognosis.
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References
Warshaw A (1992) Pancreatic carcinoma. New Engl J Med 326:455–465
Kelly M, Benjamin IS (1995) Pancreatic carcinoma. Ann Oncol 6:19–28
Connolly MM, Dawson PJ, Michelassi F, Moosa AR, Lowenstein F (1987) Survival in 1001 patients with carcinoma of the pancreas. Ann Surg 206:366–373
Ozaki H (1994) Modern surgical treatment of pancreatic cancer. Int. J Pancreatol 16:121–129
Abstracts of the workshop “Classification of pancreatic cancer staging revisited” (1994) Int J Pancreatol 16:99–120
Cameron JL, Crist DW, Sitzman JV (1991) Factors influencing survival after pancreaticoduodenectomy for pancreatic cancer. Am J Surg 161:120–125
Tsuchiya R, Noda, T, Harada M (1986) Collective review of small carcinomas of the pancreas. Ann Surg 203:77–81
Andrew-Sandberg A, Ihse I (1983) Factors influencing survival after total pancreatectomy for patients with pancreatic cancer. Ann Surg 198:605–610
Yamamoto M, Ohashi O, Ishida H, Kamigaki T, Onoyama H, Saitoh Y (1994) Relationship between survival and cancer extension. Int. J Pancreatol 16:118–120
Geer RJ, Brennan MF (1993) Prgnostic indicators for survival after resection of pancreatic adenocarcinoma. Am J Surg 165:68–73
Freeny PC, Traverso LW, Ryan JA (1993) Diagnosis and staging of pancreatic adenocarcinoma with dynamic computed tomography. Am J Surg 165:600–606
Di Carlo V, Zerbi A, Balzamo GP, Tsunoda T, Eto T, Tsuchiya R (1994) Clinical comparison of UICC and Japanese classification. Italian-Japanese experience. Int. J Pancreatol 16:104–108
Kawarada Y, Yamagisawa K, Isaji S, Mizumoto R (1994) The prevalence of pancreatic cancer lymph node metastasis in Japan and pancreatic cancer staging categories Int J Pancreatol 16: 101–104
Warshaw AL (1994) Prevalence and patterns of spread in early pancreatic adenocarcinoma. Int. J Pancreatol 16:225–227
Hermanek P, Gall FP, Wittekind C, Altendorf-Hofmann A (1994) Early-stage pancreatic ductal adenocarcinoma surgery. Int J Pancreatol 16:302–304
Pancreatic Cancer registration Committee of the Japan Pancreas Society (1993) Report of nationwide registration of pancreatic cancer patients in 1981–1992
Japan Pancreas Society (1993) General rules for the study of pancreatic cancer, 4th edn (in Japanese). Kanehara Shuppan, Tokyo
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Bassi, C., Falconi, M., Talamini, G. et al. Prospective study of the detection and treatment of small tumors of the head of the pancreas. J Hep Bil Pancr Surg 2, 347–351 (1995). https://doi.org/10.1007/BF02349248
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DOI: https://doi.org/10.1007/BF02349248