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Dilatation of the main pancreatic duct of unknown origin: causes and risk factors of pre-malignancy or malignancy

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Abstract

Introduction

A dilatation of the main pancreatic duct (MPD) is mainly due to obstructive causes (pancreatic tumor, chronic pancreatitis) or intraductal papillary mucinous neoplasm (IPMN). This study aims to assess the risk of pre-malignancy or malignancy in case of MPD dilatation with no visible mass nor obstructive calcification on computed tomography scan (CT-scan) in a population operated for it.

Patients and methods

All patients operated on from November 2015 to December 2019 in our center for a significant dilatation of the MPD without visible obstructive cause on CT-scan were included. Preoperative work-up included at least CT-scan, magnetic resonance imaging (MRI), and endoscopic ultrasonography (EUS). Primary endpoint was the final pathological diagnosis. Secondary endpoints were predictive factors of malignancy.

Results

101 patients were included, mean age 68 years-old. Final pathological data were pancreatic adenocarcinoma (n = 2), IPMN with high-grade dysplasia (n = 37), high-grade Pancreatic Intraepithelial Neoplasia (PanIN) (n = 2) (total of pre-malignant or malignant lesions: n = 41), neuroendocrine tumor (n = 6), IPMN with low-grade dysplasia (n = 45), low-grade PanIN (n = 5), chronic pancreatitis (n = 3), and benign stenosis (n = 1). On preoperative explorations, the median diameter of MPD was 7 mm [3–35]. MRI and/or EUS showed intraductal material, nodule, or cyst in 22, 32, and 52 patients, respectively; 22 patients without nodule visible on MRI or EUS had still a pre-malignant or malignant lesion. In multivariate analysis, predictive factors for pre-malignancy or malignancy were symptoms before surgery (p = 0.01), MPD dilatation without downstream stenosis (p = 0.046), and the presence of nodule (p = 0.009).

Conclusion

A dilatation of the MPD without detectable mass or obstructive calcification on CT-scan was associated with a pre-malignant or malignant lesion in 41 patients. Symptoms before surgery, MPD dilatation without duct narrowing, and the presence of nodules on MRI/EUS were associated with the risk of  pre-malignancy or malignancy.

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Abbreviations

CH:

Contrast harmonic

CI:

Confidence intervals

CT-scan:

Computed tomography scan

EUS:

Endoscopic ultrasonography

FNA:

Fine-needle aspiration

FNB:

Fine-needle biopsy

HGD:

high-grade dysplasia

HR:

Hazard ratios

IPMN:

Intraductal papillary mucinous neoplasm LGD : low-grade dysplasia 

LGD:

low-grade dysplasia

MPD:

Main pancreatic duct

MRI:

Magnetic resonance imaging

PanIN:

Pancreatic Intraepithelial Neoplasia

SD:

Standard deviation

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Acknowledgements

Guarantor of the article: Frédérique MAIRE, MD. All authors had access to the study data and reviewed and approved this final manuscript.

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Authors and Affiliations

  1. Pôle des Maladies de l’Appareil Digestif, Hôpital Beaujon, Clichy Cedex, France

    Antoine Martin, Jérôme Cros, Marie-Pierre Vullierme, Safi Dokmak, Alain Sauvanet, Philippe Levy, Vinciane Rebours & Frédérique Maire

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  1. Antoine Martin
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Correspondence to Frédérique Maire.

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Drs. Antoine Martin, Jérôme Cros, Marie-Pierre Vullierme, Safi Dokmak, Prs. Alain Sauvanet, Philippe Levy, Vinciane Rebours, and Dr. Frédérique Maire have no conflicts of interest or financial ties to disclose.

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Martin, A., Cros, J., Vullierme, MP. et al. Dilatation of the main pancreatic duct of unknown origin: causes and risk factors of pre-malignancy or malignancy. Surg Endosc 37, 3684–3690 (2023). https://doi.org/10.1007/s00464-022-09854-y

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  • DOI: https://doi.org/10.1007/s00464-022-09854-y

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