DOI QR코드

DOI QR Code

Epidemiologic Data, Tumor Size, Histologic Tumor Type and Grade, Pathologic Staging and Follow Up in Cancers of the Ampullary Region and Head of Pancreas in 311 Whipple Resection Specimens of Pakistani Patients

  • Ahmad, Zubair (Department of Pathology and Laboratory Medicine, Aga Khan University Hospital) ;
  • Ud Din, Nasir (Department of Pathology and Laboratory Medicine, Aga Khan University Hospital) ;
  • Minhas, Khurram (Department of Pathology and Laboratory Medicine, Aga Khan University Hospital) ;
  • Moeen, Sarosh (Department of Pathology and Laboratory Medicine, Aga Khan University Hospital) ;
  • Ahmed, Arsalan (Department of Pathology and Laboratory Medicine, Aga Khan University Hospital)
  • Published : 2015.12.03

Abstract

Aim: To report the histologic findings on Whipple resection specimens and thus determine the extent and spread of carcinomas of ampullary region and head of pancreas in our population. Setting: Section of Histopathology, Department of Pathology, Aga Khan University Hospital (AKUH), Karachi, Pakistan. Materials and Methods: A case series of 311 consecutive Whipple resection specimens received between January 1,2003 and December 31, 2014. Specimens processed for histologic sections and representative sections submitted and histologically examined as per established and standard protocols. All relevant tumor parameters including histologic type, histologic grade, pathologic T and N stage and tumor size were assessed. Epidemiologic data were also recorded. All findings were analysed using SPSS 19.0 software. Results: Ampullary (periampullary) carcinomas were much more common than carcinomas of the head of the pancreas, especially in males, with an average age of 53 years. Mean tumor size was 2.5 cms, over 54% were well differentiated. A large majority were pT2 or pT3 and N0. Carcinomas of pancreatic head were also more common in males, mean age was 55 years, mean tumor size was 3.5cms, and over 65% were moderately differentiated. The majority were T2 or T3 and pN1. Prognostically, significant statistical correlation was seen with tumor grade and pathologic T and N stage (p values statistically significant). However, tumor size was not statistically significant. Conclusions: Ampullary carcinomas are more common compared to pancreatic carcinomas. Majority of ampullary carcinomas were well differentiated while majority of pancreatic carcinomas were moderately differentiated. Large majority of both types of cases were pT2 or T3. Histologic tumor grade and pathologic T and N stage are significantly related to prognosis in Pakistani patients with ampullary and pancreatic cancers.

Keywords

References

  1. Abraham SC, Wilentz RE, Yeo CJ, et al (2003). Pancreaticoduodenectomy (Whipple Resections) in patients without malignancy: are they all 'chronic pancreatitis'? Am J Surg Pathol, 27, 110-20. https://doi.org/10.1097/00000478-200301000-00012
  2. Adsay V, Ohike N, Tajiri T, et al (2013). Ampullary region carcinomas: definition and site specific classification with delineation of four clinicopathologically and prognostically distinct subsets in an analysis of 249 cases. Am J Surg Pathol, 36, 1592-608.
  3. Allema JH, Reinders ME, van Gulik TM, et al (1995). Prognostic factors for survival after pancreaticoduodenectomy for patients with carcinoma of the pancreatic head region. Cancer, 75, 2069-76. https://doi.org/10.1002/1097-0142(19950415)75:8<2069::AID-CNCR2820750807>3.0.CO;2-7
  4. Amin MB, Washington K eds (2010). Reporting on Cancer Specimens Case Summaries and Background Documentation 2009, 2010. Northfield, IL, College Am Pathol.
  5. Badger SA, Brant JL, Jones C, et al (2010). The role of surgery for pancreatic cancer: a 12-year review of patient outcome. Ulster Med J, 79, 70-5.
  6. Bouvet M, Gamagami RA, Glipin EA, et al (2000). Factors influencing survival after resection for periampullary neoplasms. Am J Surg, 180, 13-7. https://doi.org/10.1016/S0002-9610(00)00405-0
  7. Cheung R (2013). Racial and social economic factors impact on the cause specific survival of pancreatic cancer: a SEER survey. Asian Pac J Cancer Prev, 14, 159-63. https://doi.org/10.7314/APJCP.2013.14.1.159
  8. Compton CC, ed (2003). Reporting on cancer specimens. case summaries and background documentation 2003 edition, northfield, IL, College Am Pathol.
  9. de Castro SM, van Heek NT, Kuhlmann KF, et al (2004). Surgical management of neoplasms of the ampulla of Vater: local resection or pancreaticoduodenectomy and prognostic features for survival. Surgery, 136, 994-1002. https://doi.org/10.1016/j.surg.2004.03.010
  10. Foroughi F, Mohsenifar Z, Ahmadvand A, et al (2012). Pathologic findings of whipple pancreaticoduodenectomy: a 5-year review on 51 cases at Taleghani general hospital. Gastrointerol Hepatol bed Bench, 5, 179-82.
  11. Gudjonsson B (1987). Cancer of the pancreas. 50 years of surgery. Cancer, 60, 2284-303. https://doi.org/10.1002/1097-0142(19871101)60:9<2284::AID-CNCR2820600930>3.0.CO;2-V
  12. Hadizadeh M, Padashi M, Mohammad Alizadeh AH, Zali MR (2014). Clinical, laboratory biomarkers and imaging findings of pancreatic adenocarcinoma in Iran. Asian Pac J Cancer Prev, 15, 4349-52. https://doi.org/10.7314/APJCP.2014.15.10.4349
  13. Kang HJ, Eo SH, Kim SC, et al (2013). Increased number of metastatic lymph nodes in adenocarcinoma of the ampulla of Vater as a prognostic factor: a proposal of new nodal classification. Surgery, 155, 74-84.
  14. Kavanagh DO, O' Riain C, Ridgway PF, et al (2008). Radical pancreaticoduodenectomy for benign disease. Sci World J, 22, 1156-67.
  15. Kayahara M, Ohta T (2010). Gross appearance of the ampullary tumor predicts lymph node metastases and outcome. Dig Surg, 27, 127-31. https://doi.org/10.1159/000286839
  16. Lazaryan A, Almhanna K, Elson P, et al (2008). Factors associated with tumor recurrence and 5-year postoperative survival in ampullary carcinoma. cleveland clinic experience. J Clin Oncol, 26, 155-75.
  17. Longmire WP Jr, Traverso LW (1981). The Whipple procedure and other standard operative approaches to pancreatic cancer. Cancer, 47, 1706-11. https://doi.org/10.1002/1097-0142(19810315)47:6+<1706::AID-CNCR2820471441>3.0.CO;2-7
  18. Luke C, Price T, Karapetis C, Singhal N, Roder D (2009). Pancreatic cancer epidemiology and survival in an australian population. Asian Pac J Cancer Prev, 10, 369-74.
  19. Martin FM, Rossi RL, Dorrucci V, et al (1990). Clinical and pathologic correlations in patients with periampully tumors. Arch Surg, 125, 723-6. https://doi.org/10.1001/archsurg.1990.01410180041008
  20. Morris-stiff G, Alabraba E, Tan TM, et al (2009). Assessment of survival advantage in ampullary carcinoma in relation to tumor biology and morphology. Eur J Surg Oncol, 35, 746-50. https://doi.org/10.1016/j.ejso.2008.10.010
  21. Mu DQ, Peng SY, Wang GF (2004). Risk factors influencing recurrence following resection of pancreatic head cancer. World J Gastroenterol, 10, 906-9. https://doi.org/10.3748/wjg.v10.i6.906
  22. Nix GA, Dubbelman C, Wilson JH, et al (1991). Prognostic implications of tumor diameter in carcinoma of the head of the pancreas. Cancer, 67, 529-35. https://doi.org/10.1002/1097-0142(19910115)67:2<529::AID-CNCR2820670235>3.0.CO;2-3
  23. Qureshi A, Hassan U, Azam M (2011). Morphology, TNM staging and survival with pancreaticoduodenectomy specimens received at shaukat khanum memorial cancer hospital and research center, Pakistan. Asian Pac J Cancer Prev, 12, 953-6.
  24. Rosai J ed (2004). Guidelines for handling of most common and important surgical specimens. rosai and ackerman's surgical pathology. 9th edition, Mosby, St Louis, Missouri.
  25. Sessa F, Furlan D, Zampatti C, et al (2007). Prognostic factors for ampullary adenocarcinomas: tumor stage, tumor histology, tumor location, immunohistochemistry and microsatellite instability. Virchows Arch, 451, 649-57. https://doi.org/10.1007/s00428-007-0444-1
  26. Shrikhande SV, Barreto SG, Somashekar BA, et al (2013). Evoluation of pancreatoduodenectomy in a tertiary cancer center in India: Improved results from service recognition. Pancreaticol, 13, 63-71. https://doi.org/10.1016/j.pan.2012.11.302
  27. Sohn TA, Campbell KA, Pitt HA, et al (2000). Quality of life and long-term survival after surgery for chronic pancreatitis. J Gastrointest Surg, 4, 355-64. https://doi.org/10.1016/S1091-255X(00)80013-X
  28. Sohn TA, Yeo CJ, Cameros JL, et al (2000). Resected adenocarcinoma of the pancreas-616 patients: results, outcomes, and prognostic indicators. J Gastrointest Surg, 4, 567-79. https://doi.org/10.1016/S1091-255X(00)80105-5
  29. Tepper J, Nardi G, Sutt H (1976). Carcinoma of the pancreas. Review of MGH expression from 1963 to 1973. Analysis of surgical failure and implications for radiation therapy. Cancer, 37, 1519-24. https://doi.org/10.1002/1097-0142(197603)37:3<1519::AID-CNCR2820370340>3.0.CO;2-O
  30. Thomas RM, Ahmad SA (2012). Current concepts in the surgical management of pancreatic cancer. Surg Oncol Clin N Am, 19, 335-58.
  31. Unal OU, Oztop I, Assoc TK, et al (2014). Prognostic factors and adjuvant treatments for surgically treated cancers of the biliary tract: a multicentric study of the anatolian society of medical oncology (ASMO). Asian Pac J Cancer Prev, 15, 9687-92. https://doi.org/10.7314/APJCP.2014.15.22.9687
  32. van Roest MH, Gouw AS, Peeters PM, et al (2008). Results of pancreaticoduodenectomy in patients with periampullary adenocarcinoma:perineural growth more important prognostic factor than tumor localization. Ann Surg, 248, 97-103. https://doi.org/10.1097/SLA.0b013e31817b6609
  33. Whipple AO, Parsons WB, Mullins CR (1935). Treatment of carcinoma of the ampulla of Vater. Ann Surg, 102, 763-79. https://doi.org/10.1097/00000658-193510000-00023
  34. Willett CG, Warshaw AL, Convery K, et al (1993). Patterns of failure after pancreaticoduodenectomy for ampullary carcinoma. Surg Gynecol Obstet, 176, 33-8.
  35. Yamaguchi K, Enjoji M (1987). Carcinoma of the ampulla of vater. A clinicopathologic study and pathologic staging of 109 cases of carcinoma and 5 cases of adenoma. Cancer, 59, 506-15. https://doi.org/10.1002/1097-0142(19870201)59:3<506::AID-CNCR2820590326>3.0.CO;2-#
  36. Yeo CJ, Cameron JL, Sohn TA, et al (1997). Six hundred fifty consective pancreaticoduodenectomies in the 1990s: pathology, complications and outcomes. Ann Surg, 226, 248-57. https://doi.org/10.1097/00000658-199709000-00004
  37. Zahir ST, Arjmand A, Kargar S, Neishaboury M (2013). Incidence and trends of malignant and benign pancreatic lesions in Yazd, Iran between 2001 and 2011. Asian Pac J Cancer Prev, 14, 2631-35. https://doi.org/10.7314/APJCP.2013.14.4.2631

Cited by

  1. Errors in Surgical Pathology Reports: a Study from a Major Center in Pakistan vol.17, pp.4, 2016, https://doi.org/10.7314/APJCP.2016.17.4.1869
  2. Impact factors for perioperative morbidity and mortality and repercussion of perioperative morbidity and long-term survival in pancreatic head resection vol.52, pp.1, 2018, https://doi.org/10.1515/raon-2017-0036