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, 陳汝福, 林青, 等. 胰管結石合并胰腺癌的診斷及外科治療. 中華普通外科學文獻: 電子版, 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.	陳勇軍, 田銳, 王敏, 等. 胰管結石的分型及外科治療方式的選擇. 中華外科雜志, 2013, 51(8): 688-690.
9.	Braganza JM, Lee SH, McCloy RF, et al. Chronic pancreatitis. Lancet, 2011, 377(9772): 1184-1197.
10.	王洛偉, 李兆申, 李淑德, 等. 慢性胰腺炎全國多中心流行病學調查. 胰腺病學, 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.	熊先澤, 敬靜, 彭其芳. 胰管結石慢性胰腺炎的診治. 中國普外基礎與臨床雜志, 2007, 14(1): 94-95.
16.	何振平, 鄧有松, 馬寬生, 等. 胰管結石與并發胰腺癌. 中華肝膽外科雜志, 2002, 8(2): 90-92.
17.	楊威, 鄭鑫, 劉青光, 等. 胰管結石合并胰腺癌10 例診治回顧分析. 中國普外基礎與臨床雜志, 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.	戴夢華, 趙玉沛, 蔡力行, 等. 外周血K-ras 基因突變和CA19-9 的聯合檢測在胰腺癌診斷中的作用. 中華外科雜志, 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, 廖專, 葉博, 等. 體外震波碎石術治療慢性胰腺炎胰管結石100 例初步經驗. 中華胰腺病雜志, 2012, 12(1): 3-5.
28.	孫備, 李樂. 胰腺癌行標準與擴大的胰腺切除術定義與手術范圍—— 2013 國際胰腺外科研究組共識解讀. 中國實用外科雜志, 2015, 35(1): 11-15.
29.	孫備, 陳華. 胰腺癌外科治療的現狀與展望. 中國普外基礎與臨床雜志, 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, 程東峰, 沈柏用, 等. 胰十二指腸切除術聯合血管切除的術前、術中評估和操作要點. 中國普外基礎與臨床雜志, 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, 陳汝福, 林青, 等. 胰管結石合并胰腺癌的診斷及外科治療. 中華普通外科學文獻: 電子版, 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. 陳勇軍, 田銳, 王敏, 等. 胰管結石的分型及外科治療方式的選擇. 中華外科雜志, 2013, 51(8): 688-690.
9. Braganza JM, Lee SH, McCloy RF, et al. Chronic pancreatitis. Lancet, 2011, 377(9772): 1184-1197.
10. 王洛偉, 李兆申, 李淑德, 等. 慢性胰腺炎全國多中心流行病學調查. 胰腺病學, 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. 熊先澤, 敬靜, 彭其芳. 胰管結石慢性胰腺炎的診治. 中國普外基礎與臨床雜志, 2007, 14(1): 94-95.
16. 何振平, 鄧有松, 馬寬生, 等. 胰管結石與并發胰腺癌. 中華肝膽外科雜志, 2002, 8(2): 90-92.
17. 楊威, 鄭鑫, 劉青光, 等. 胰管結石合并胰腺癌10 例診治回顧分析. 中國普外基礎與臨床雜志, 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. 戴夢華, 趙玉沛, 蔡力行, 等. 外周血K-ras 基因突變和CA19-9 的聯合檢測在胰腺癌診斷中的作用. 中華外科雜志, 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, 廖專, 葉博, 等. 體外震波碎石術治療慢性胰腺炎胰管結石100 例初步經驗. 中華胰腺病雜志, 2012, 12(1): 3-5.
28. 孫備, 李樂. 胰腺癌行標準與擴大的胰腺切除術定義與手術范圍—— 2013 國際胰腺外科研究組共識解讀. 中國實用外科雜志, 2015, 35(1): 11-15.
29. 孫備, 陳華. 胰腺癌外科治療的現狀與展望. 中國普外基礎與臨床雜志, 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, 程東峰, 沈柏用, 等. 胰十二指腸切除術聯合血管切除的術前、術中評估和操作要點. 中國普外基礎與臨床雜志, 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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