Diagnosis and Surgical Treatment for Pancreatic Ductal Stones Combined with Pancreatic Cancer: A Report of 9 Cases_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 ZHOUQuan-bo , YELiang-tao , LIGuo-lin , YEHui-lin ,  CHENRu-fu

Department of Hepatobiliary Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China;

Corresponding author：

CHENRu-fu, Email: chenrf63@163.com

Keywords：

Pancreatic ductal stones; Pancreatic cancer; Diagnosis; Surgical therapy

DOI：

10.7507/1007-9424.20160179

Video：

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Objective To summarize the diagnosis and surgical treatment experience of pancreatic ductal stones combined with pancreatic cancer. Methods Nine cases of pancreatic ductal stones combined with pancreatic cancer who treated in our hospital from January 2005 to December 2015 were collected to make a retrospective analysis, summarizing the clinical features, imaging diagnosis, and surgical treatment. Results Four of 9 cases received ultrasound combined with CT angiography, and all of them were diagnosed as pancreatic ductal stones combined with pancreatic cancer; 4 cases received magnetic resonance cholangiopancreatography (MRCP)/magnetic resonance angiography (MRA), and 3 cases were considered as pancreatic ductal stones combined with pancreatic cancer; 3 cases received endoscopic retrograde cholangiopancreatography (ERCP), and all of them were diagnosed as pancreatic cancer. All of the 9 cases underwent surgery, including 4 cases of pancreaticoduodenectomy, 3 cases of distal pancreatectomy with splenectomy, 1 case of pancreatolithotomy plus distal pancreaticojejunostomy, and 1 case of laparoscopic exploration with biopsy. No one died after surgery, but gastric stress ulcer bleeding happened in 1 case, and class B pancreatic fistula happened in 1 case. All of the 9 cases were followed-up for 5-36 months, with the median were 13 months. Seven cases died during follow up period, 5 cases survived longer than 1 year, and 2 cases survived longer than 3 years. Conclusions For patients with recurrent pancreatic stones, we should be wary of the possibility of combining pancreatic cancer, CT and MRCP can be used as further examination of this disease, a variety of imaging methods combination can improve the diagnosis. If imaging examination reveals swollen pancreas without surgical contraindications, surgery is necessary, and standard pancreaticoduodenectomy or pancreas body and tail resection is recommended.

Citation： ZHOUQuan-bo, YELiang-tao, LIGuo-lin, YEHui-lin, CHENRu-fu. Diagnosis and Surgical Treatment for Pancreatic Ductal Stones Combined with Pancreatic Cancer: A Report of 9 Cases. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2016, 23(6): 663-666. doi: 10.7507/1007-9424.20160179 Copy

1.	Ma ZH, Ma QY, Sha HC, et al. Magnetic resonance cholangiopancreatography for the detection of pancreatic duct stones in patients with chronic pancreatitis. World J Gastroenterol, 2009, 15(20): 2543- 2546.
2.	Li JS, Zhang ZD, Tang Y, et al. Retrospective analysis of 88 patients with pancreatic duct stone. Hepatobiliary Pancreat Dis Int, 2007, 6(2): 208-212.
3.	Li L, Zhang SN. Management of pancreatic duct stone. Hepatobiliary Pancreat Dis Int, 2008, 7(1): 9-10.
4.	周泉波, 陈汝福, 林青, 等. 胰管结石合并胰腺癌的诊断及外科治疗. 中华普通外科学文献: 电子版, 2010, 4(3): 220-223.
5.	Lowenfels AB, Maisonneuve P, Cavallini G, et al. Pancreatitis and the risk of pancreatic cancer. International Pancreatitis Study Group. N Engl J Med, 1993, 328(20): 1433-1437.
6.	Malka D, Hammel P, Maire F, et al. Risk of pancreatic adenocarcinoma in chronic pancreatitis. Gut, 2002, 51(6): 849-852.
7.	Fernandez E, La Vecchia C, Porta M, et al. Pancreatitis and the risk of pancreatic cancer. Pancreas, 1995, 11(2): 185-189.
8.	陈勇军, 田锐, 王敏, 等. 胰管结石的分型及外科治疗方式的选择. 中华外科杂志, 2013, 51(8): 688-690.
9.	Braganza JM, Lee SH, McCloy RF, et al. Chronic pancreatitis. Lancet, 2011, 377(9772): 1184-1197.
10.	王洛伟, 李兆申, 李淑德, 等. 慢性胰腺炎全国多中心流行病学调查. 胰腺病学, 2007, 7(1): 1-5.
11.	Sakorafas GH, Tsiotou AG, Peros G. Mechanisms and natural history of pain in chronic pancreatitis: a surgical perspective. J Clin Gastroenterol, 2007, 41(7): 689-699.
12.	Fang WL, Shyr YM, Su CH, et al. Long-term follow-up study of surgical treatment for pancreatic stones. Hepatogastroenterology, 2007, 54(73): 246-249.
13.	Plesman RL, Norris A, Ringwood PB. What is your diagnosis? Pancreatolithiasis. J Am Vet Med Assoc, 2014, 244(6): 647-649.
14.	Machiki Y, Nimura Y, Kamiya J, et al. Clinicopathologic study on pancreatic cancer associated with pancreatic stones. Int J Pancreatol, 1997, 22(3): 187-191.
15.	熊先泽, 敬静, 彭其芳. 胰管结石慢性胰腺炎的诊治. 中国普外基础与临床杂志, 2007, 14(1): 94-95.
16.	何振平, 邓有松, 马宽生, 等. 胰管结石与并发胰腺癌. 中华肝胆外科杂志, 2002, 8(2): 90-92.
17.	杨威, 郑鑫, 刘青光, 等. 胰管结石合并胰腺癌10 例诊治回顾分析. 中国普外基础与临床杂志, 2009, 16(2): 141-144.
18.	Anderson SW, Soto JA. Pancreatic duct evaluation: accuracy of portal venous phase 64 MDCT. Abdom Imaging, 2009, 34(1): 55-63.
19.	Anderson SW, Zajick D, Lucey BC, et al. 64-detector row computed tomography: an improved tool for evaluating the biliary and pancreatic ducts?. Curr Probl Diagn Radiol, 2007, 36(6): 258-271.
20.	Farnbacher MJ, Schoen C, Rabenstein T, et al. Pancreatic duct stones in chronic pancreatitis: criteria for treatment intensity and success. Gastrointest Endosc, 2002, 56(4): 501-506.
21.	Okusaka T, Yamada T, Maekawa M. Serum tumor markers for pancreatic cancer: the dawn of new era?. JOP, 2006, 7(4): 332-336.
22.	戴梦华, 赵玉沛, 蔡力行, 等. 外周血K-ras 基因突变和CA19-9 的联合检测在胰腺癌诊断中的作用. 中华外科杂志, 2003, 41(5): 332-335.
23.	Strobel K, Heinrich S, Bhure U, et al. Contrast-enhanced 18F-FDG PET/CT: 1-stop-shop imaging for assessing the resectability of pancreatic cancer. J Nucl Med, 2008, 49(9): 1408-1413.
24.	Hong J, Wang J, Keleman AM, et al. Endoscopic versus surgical treatment of downstream pancreatic duct stones in chronic pancreatitis. Am Surg, 2011, 77(11): 1531-1538.
25.	Cahen DL, Gouma DJ, Nio Y, et al. Endoscopic versus surgical drainage of the pancreatic duct in chronic pancreatitis. N Engl J Med, 2007, 356(7): 676-684.
26.	Inui K, Tazuma S, Yamaguchi T, et al. Treatment of pancreatic stones with extracorporeal shock wave lithotripsy: results of a multicenter survey. Pancreas, 2005, 30(1): 26-30.
27.	胡良嗥, 廖专, 叶博, 等. 体外震波碎石术治疗慢性胰腺炎胰管结石100 例初步经验. 中华胰腺病杂志, 2012, 12(1): 3-5.
28.	孙备, 李乐. 胰腺癌行标准与扩大的胰腺切除术定义与手术范围—— 2013 国际胰腺外科研究组共识解读. 中国实用外科杂志, 2015, 35(1): 11-15.
29.	孙备, 陈华. 胰腺癌外科治疗的现状与展望. 中国普外基础与临床杂志, 2008, 15(8): 547-549.
30.	Suzuki Y, Sugiyama M, Inui K, et al. Management for pancreatolithiasis: a Japanese multicenter study. Pancreas, 2013, 42(4): 584-588.
31.	彭承宏, 程东峰, 沈柏用, 等. 胰十二指肠切除术联合血管切除的术前、术中评估和操作要点. 中国普外基础与临床杂志, 2006, 13(5): 506-510.

1. Ma ZH, Ma QY, Sha HC, et al. Magnetic resonance cholangiopancreatography for the detection of pancreatic duct stones in patients with chronic pancreatitis. World J Gastroenterol, 2009, 15(20): 2543- 2546.
2. Li JS, Zhang ZD, Tang Y, et al. Retrospective analysis of 88 patients with pancreatic duct stone. Hepatobiliary Pancreat Dis Int, 2007, 6(2): 208-212.
3. Li L, Zhang SN. Management of pancreatic duct stone. Hepatobiliary Pancreat Dis Int, 2008, 7(1): 9-10.
4. 周泉波, 陈汝福, 林青, 等. 胰管结石合并胰腺癌的诊断及外科治疗. 中华普通外科学文献: 电子版, 2010, 4(3): 220-223.
5. Lowenfels AB, Maisonneuve P, Cavallini G, et al. Pancreatitis and the risk of pancreatic cancer. International Pancreatitis Study Group. N Engl J Med, 1993, 328(20): 1433-1437.
6. Malka D, Hammel P, Maire F, et al. Risk of pancreatic adenocarcinoma in chronic pancreatitis. Gut, 2002, 51(6): 849-852.
7. Fernandez E, La Vecchia C, Porta M, et al. Pancreatitis and the risk of pancreatic cancer. Pancreas, 1995, 11(2): 185-189.
8. 陈勇军, 田锐, 王敏, 等. 胰管结石的分型及外科治疗方式的选择. 中华外科杂志, 2013, 51(8): 688-690.
9. Braganza JM, Lee SH, McCloy RF, et al. Chronic pancreatitis. Lancet, 2011, 377(9772): 1184-1197.
10. 王洛伟, 李兆申, 李淑德, 等. 慢性胰腺炎全国多中心流行病学调查. 胰腺病学, 2007, 7(1): 1-5.
11. Sakorafas GH, Tsiotou AG, Peros G. Mechanisms and natural history of pain in chronic pancreatitis: a surgical perspective. J Clin Gastroenterol, 2007, 41(7): 689-699.
12. Fang WL, Shyr YM, Su CH, et al. Long-term follow-up study of surgical treatment for pancreatic stones. Hepatogastroenterology, 2007, 54(73): 246-249.
13. Plesman RL, Norris A, Ringwood PB. What is your diagnosis? Pancreatolithiasis. J Am Vet Med Assoc, 2014, 244(6): 647-649.
14. Machiki Y, Nimura Y, Kamiya J, et al. Clinicopathologic study on pancreatic cancer associated with pancreatic stones. Int J Pancreatol, 1997, 22(3): 187-191.
15. 熊先泽, 敬静, 彭其芳. 胰管结石慢性胰腺炎的诊治. 中国普外基础与临床杂志, 2007, 14(1): 94-95.
16. 何振平, 邓有松, 马宽生, 等. 胰管结石与并发胰腺癌. 中华肝胆外科杂志, 2002, 8(2): 90-92.
17. 杨威, 郑鑫, 刘青光, 等. 胰管结石合并胰腺癌10 例诊治回顾分析. 中国普外基础与临床杂志, 2009, 16(2): 141-144.
18. Anderson SW, Soto JA. Pancreatic duct evaluation: accuracy of portal venous phase 64 MDCT. Abdom Imaging, 2009, 34(1): 55-63.
19. Anderson SW, Zajick D, Lucey BC, et al. 64-detector row computed tomography: an improved tool for evaluating the biliary and pancreatic ducts?. Curr Probl Diagn Radiol, 2007, 36(6): 258-271.
20. Farnbacher MJ, Schoen C, Rabenstein T, et al. Pancreatic duct stones in chronic pancreatitis: criteria for treatment intensity and success. Gastrointest Endosc, 2002, 56(4): 501-506.
21. Okusaka T, Yamada T, Maekawa M. Serum tumor markers for pancreatic cancer: the dawn of new era?. JOP, 2006, 7(4): 332-336.
22. 戴梦华, 赵玉沛, 蔡力行, 等. 外周血K-ras 基因突变和CA19-9 的联合检测在胰腺癌诊断中的作用. 中华外科杂志, 2003, 41(5): 332-335.
23. Strobel K, Heinrich S, Bhure U, et al. Contrast-enhanced 18F-FDG PET/CT: 1-stop-shop imaging for assessing the resectability of pancreatic cancer. J Nucl Med, 2008, 49(9): 1408-1413.
24. Hong J, Wang J, Keleman AM, et al. Endoscopic versus surgical treatment of downstream pancreatic duct stones in chronic pancreatitis. Am Surg, 2011, 77(11): 1531-1538.
25. Cahen DL, Gouma DJ, Nio Y, et al. Endoscopic versus surgical drainage of the pancreatic duct in chronic pancreatitis. N Engl J Med, 2007, 356(7): 676-684.
26. Inui K, Tazuma S, Yamaguchi T, et al. Treatment of pancreatic stones with extracorporeal shock wave lithotripsy: results of a multicenter survey. Pancreas, 2005, 30(1): 26-30.
27. 胡良嗥, 廖专, 叶博, 等. 体外震波碎石术治疗慢性胰腺炎胰管结石100 例初步经验. 中华胰腺病杂志, 2012, 12(1): 3-5.
28. 孙备, 李乐. 胰腺癌行标准与扩大的胰腺切除术定义与手术范围—— 2013 国际胰腺外科研究组共识解读. 中国实用外科杂志, 2015, 35(1): 11-15.
29. 孙备, 陈华. 胰腺癌外科治疗的现状与展望. 中国普外基础与临床杂志, 2008, 15(8): 547-549.
30. Suzuki Y, Sugiyama M, Inui K, et al. Management for pancreatolithiasis: a Japanese multicenter study. Pancreas, 2013, 42(4): 584-588.
31. 彭承宏, 程东峰, 沈柏用, 等. 胰十二指肠切除术联合血管切除的术前、术中评估和操作要点. 中国普外基础与临床杂志, 2006, 13(5): 506-510.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Diagnosis and Surgical Treatment for Pancreatic Ductal Stones Combined with Pancreatic Cancer: A Report of 9 Cases

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