Acute pancreatitis in patients with pancreatic cancer

Abstract

Acute pancreatitis (AP) is a rare manifestation of pancreatic cancer (PC). The relationship between AP and PC remains less distinct.From January 2009 to November 2015, 47consecutive patients with PC who presented with AP were reviewed for this study. Clinical features, clinicopathologic variables, postoperative complications, and follow-up evaluations of patients were documented in detail from our database. In order to identify cutoff threshold time for surgery, receiver operating curve (ROC) was built according to patients with or without postoperative complications. Cumulative rate of survival was calculated by using the Kaplan–Meier method. The study was conducted in accordance with the principles of the Declaration of Helsinki and the guidelines of West China Hospital.This study included 35 men (74.5%) and 12 women (25.5%) (mean age: 52 years), with a median follow-up of 40 months. AP was clinically mild in 45 (95.7%) and severe in 2 (4.3%). The diagnosis of PC was delayed by 2 to 660 days (median 101 days). Thirty-nine (83.0%) cases underwent surgery. Eight (17.0%) cases performed biopsies only. Of 39 patients, radical surgery was performed in 32 (82.1%) cases and palliative in 7 (19.9%) cases. Two (8.0%) patients were needed for vascular resection and reconstruction. Postoperative complications occurred in 12 (30.8%) patients. About 24.5 days was the best cutoff point, with an area under curve (AUC) of 0.727 (P = 0.025, 95% confidence interval: 0.555–0.8999). The survival rate of patients at 1 year was 23.4%. The median survival in patients with vascular resection and reconstruction was 18 months, compared with 10 months in patients without vascular resection (P = 0.042). For the primary stage (T), Tix was identified in 3 patients, the survival of whom were 5, 28, 50 months, respectively. And 2 of them were still alive at the follow-up period.The severity of AP was mainly mild. Surgical intervention after 24.5 days may benefit for reducing postoperative complications. Patients with vascular resection and reconstruction, thus achieving tumor-free margins, had a long-time survival.

Recurrence and survival after surgery for pancreatic cancer with or without acute pancreatitis

“…Mujicaet reported that the overall survival rates at six months and 12 months in PDAC patients who presented initially with AP were 51% (23 cases) and 28% (13 cases), respectively[16]. A recent study at our medical center reported a survival rate of 23.4%(11 cases) at one year in PDAC patients with AP[17]. Consistent with this report, our previous study found that AP was negatively correlated with both overall survival and early recurrence (within 12 mo).…”

“…Our group recently demonstrated that the short-term outcome of pancreatic cancer patients after surgery is adversely affected by AP[15]. Adverse effects of perioperative AP include delayed surgical treatment, longer hospital stay, higher cost of treatment and a reduced quality of life, and may be related to premature mortality[14,16,17].…”

Pancreatic Cancer Masked by Acute Pancreatitis as well as an Unusual Iatrogenic Complication

“…[1][2][3] The frequency of AP in pancreatic cancer patient has been reported to vary from 6.8% to 13.8% and majority of patients present with mild AP. [4][5][6] The ductal adenocarcinoma causes AP by obstructing the main PD, producing ductal hypertension, and consequent leakage of enzymes. These patients are usually misdiagnosed and the underlying malignancy…”

“…is usually hidden because of various reasons such as diffuse pancreatic inflammation in AP could mask the underlying mass lesion or a small-sized obstructing tumor may be missed on cross-sectional imaging. [6,7] In these cases, FDG PET-CT or EUS may help in detection of small lesions as was in the index case. [6,8] Peripancreatic PA is usually formed due to injury to the peripancreatic artery either because of pancreatitis, trauma, percutaneous or endoscopic interventional procedures, or abdominal surgery, leading on to leakage of blood into the surrounding tissue and formation of a blood-formed cavity communicating with the damaged artery.…”

“…[6,7] In these cases, FDG PET-CT or EUS may help in detection of small lesions as was in the index case. [6,8] Peripancreatic PA is usually formed due to injury to the peripancreatic artery either because of pancreatitis, trauma, percutaneous or endoscopic interventional procedures, or abdominal surgery, leading on to leakage of blood into the surrounding tissue and formation of a blood-formed cavity communicating with the damaged artery. [9] However, the formation of PA following image-guided FNA is very rare and has been described in occasional case reports.…”