Periampüller bölge tümörlerinin retrospektif analizi

Amaç: Tüm gastrointestinal kanserlerin %5’ini oluşturan periampüller bölge tümörleri ile ilgili her geçen gün birçok araştırma yapılmakla beraber, prognoz bakımından gelişmeler sınırlıdır. Literatürde, periampüller bölgenin pankreas dışı tümörlerine ait çok az sayıda geniş çaplı araştırma mevcuttur. Bu konudaki bilgi birikiminin artması ve gelecekte tedavi stratejilerine yön göstermesi için bu çalışmayı planladık.Gereç ve Yöntemler: İstanbul Eğitim ve Araştırma Hastanesine 1996-2012 yılları arasında gelen 132 pankreatikoduodenektomi/distal pankreatektomi materyali cinsiyet, yaş, tümör lokalizasyonu, tümör boyutu, histolojik alt tip, tümör evresi, tümörün diferansiasyonu, lenf nodu metastazı varlığı, preneoplastik lezyonlar ve prognoz açısından araştırıldı.Bulgular: Çalışmamızda cinsiyet, yaş, tümör boyutu, grade, stage ile ilgili bulgularımız literatür bilgileri ile uyumlu olmakla beraber histolojik alt tip, lenf nodu metastazı ve prognoz ile ilgili bulgularımız ise literatür bulguları ile yer yer değişiklikler göstermiştir.Sonuç: Çalışmamızda izlenen ufak farklılıklar olgu sayısının azlığı ve hasta seçiminden kaynaklı olabileceği gibi, çevresel ve genetik faktörlerin etken olması da söz konusu olabilir. Bu farklılıklar üzerine daha geniş çalışmalara ihtiyaç vardır.

Anahtar Kelimeler:

Periampüller bölge tümörleri, pankreas, ampulla, distal koledok, periampüller duodenal bölge, retrospektif analiz

The retrospective analysis of periampullary region tumors

Aim: The periampullary regional tumors which constitute 5% of all gastrointestinal cancers are being investigated day by day, but their prognosis is limited. In the literature, there are few large-scale studies of non-pancreatic tumors of the periampullary region. We planned this study because the knowledge accumulation in this area will be able to guide the treatment strategies in the future.Materials and Methods: 132 pancreaticoduodenectomy / distal pancreatectomy materials operated between 1996-2012 were researched in terms of gender, age, tumor localization, tumor size, histologic subtype, tumor stage, tumor differentiation, presence of lymph node metastasis, preneoplastic lesions and prognosis in the Department of Pathology, Istanbul Education and Research Hospital.Results: In our study, findings related to sex, age, tumor size, grade, and stage were consistent with the literature, while histological subtype, lymph node metastasis and prognosis showed minor differences.Conclusions: Minor differences in our study may be due to low number of cases and patient selection, as well as environmental and genetic factors. Further studies on these differences are needed.

Keywords:

Periampullary region tumors, pancreas, ampullary, distal choledochus, periampullary duodenal region, retrospective analysis,

PDF

___

Ding H, Zhou P, Xu M, Chen W, Li Q, Chen T, ve ark. Combining endoscopic ultrasound and tumor markers improves the diagnostic yield on the etiology of common bile duct dilation secondary to periampullary pathologies. Ann Transl Med. 2019 Jul;7(14):314.
Lu J, Hu D, Tang H, Hu X, Shen Y, Li Z, ve ark. Assessment of tumor heterogeneity: Differentiation of periampullary neoplasms based on CT whole-lesion histogram analysis. Eur J Radiol. 2019 Jun;115:1-9.
Thapa P. Epidemiology of pancreatic and periampullary cancer. Indian J Surg. 2015 Oct;77(5):358-61.
Filiz G, Yerci O, Adim SB, ve ark. Periampullary carcinomas. Hepatogastroenterology. 2007;54(76):1247-1249.
Dhakhwa R, Kafle N. Histopathologic analysis of pancreaticoduodenectomy specimen. JNMA j nepal med assoc. 2016;55(204):79-85.
Nuzzo G, Clemente G, Cadeddu F, Giovannini I. Palliation of unresectable periampullary neoplasms:”Surgical” versus “non-surgical” approach. Hepatogastroenterol 2004;51:1282-5.
Sunil BJ, Seshadri RA, Gouthaman S, Ranganathan R. Long-term outcomes and prognostic factors in periampullary carcinoma. J gastrointest cancer. 2016. (doi: 10.1007/s12029-016-9863-z).
Acharya A, Markar SR, Sodergren MH, Malietzis G, Darzi A, Athanasiou T, Khan AZ. Meta-analysis of adjuvant therapy following curative surgery for periampullary adenocarcinoma. Br J Surg. 2017;104(7):814-822.
Sobin LH, Compton CC. TNM seventh edition: what’s new, what’s changed: communication from the International Union Against Cancer and the American Joint Committee on Cancer. Cancer. 2010;116(22):5336–9.
Raimondi S, Lowenfels AB, Morselli-Labate AM, Maisonneuve P, Pezzilli R. Pancreatic cancer in chronic pancreatitis: Etiology, incidence, and early detection. Best Pract Res Clin Gastroenterol 2010;24(3):349-58.
Hruban RH, Wilentz RE, Kern SE. Genetic progression in the pancreatic ducts. Am J Pathol 2000;156:1821–25.
Bosman FT, Carneiro F, Hruban RH, Theise ND. WHO classification of tumors of the digestive system, 4. Lyon, International Agency for Research in Cancer 2010:280-331.
Yamakawa K, Nakano-Narusawa Y, Hashimoto N, Yokohira M, Matsuda Y. Development and Clinical Trials of Nucleic Acid Medicines for Pancreatic Cancer Treatment. Int J Mol Sci. 2019 Aug 29;20(17): E4224
Chen Y, Wang YR, Deng GC, Dai GH. CA19-9 decrease and survival according to platelet level in patients with advanced pancreatic cancer. BMC Cancer. 2019 Aug 30;19(1):860.
Taher MA, Khan ZR, Chowdhury MM, Nur-E-Elahi M, Chowdhury AK, Faruque MS, ve ark. Pylorus preserving pancreaticoduodenectomy vs. standard whipple’s procedure in case of carcinomahead of the pancreas and periampullary carcinoma. Mymensingh Ned J. 2015 Apr;24(2): 319-25.
Horner MJ, Ries LAG, Kapcho M, Neyman N, Aminou R, Howlader N ve ark. Seer cancer statics review, Howlader N (eds), National Cancer Institute, Bethesda, MD. 2009:1975-2006.
Chung YE, Kim MJ, Park MS, Choi JY, Kim H, Kim SK, ve ark. Differential features of pancreatobiliary-and intestinal type ampullary carcinomas at MR imaging. Radiology 2010;257:384-93.
Doepker MP, Thompson ZJ, Centeno BA, Kim RD, Wong J, Hodul PJ. Clinicopathologic and survival analysis of resected ampullary adenocarcinoma. J Surg Oncol. 2016 Aug;114(2):170-5.
Chen SC, Shyr YM, Chou SC, Wang SE. The role of lymph nodes in predicting the prognosis of ampullary carcinoma after curative resection. World j surg oncol. 2015 Jul 25;13:224.
Murakami T, Matsuyama R, Ueda M, Mochizuki Y, Homma Y, Kameda K, ve ark. High-Mobility Group Box 1 expression predicts survival of patients after resection of adenocarcinoma of the ampulla of Vater. World J Surg Oncol. 2019 Aug 9;17(1):140.
Strasberg SM, Drebin JA. Tumors of the biliary tree cholangiocarcinoma. Textbook of gastroenterology, Yamada T, Alpers DH, Laine L et al (eds). Lippincott Williams & Wilkins, Philadelphia 1999;101;2201-18.
Gonzalez RS, Bagci P, Basturk O, Reid MD, Balci S, Knight JH, ve ark. Intrapancreatic distal common bile duct carcinoma: Analysis, staging considerations, and comparison with pancreatic ductal and ampullary adenocarcinomas. Mod pathol. 2016 Nov;29(11):1358-69.
Wirasorn K, Ngamprasertchai T, Chindaprasirt J, Sookprasert A, Khantikaew N, Pakkhem A. Piti ungarereevittaya prognostic factors in resectable cholangiocarcinoma patients: Carcinoembryonic antigen, lymph node, surgical margin and chemotherapy. World J Gastrointest Oncol 2013;5(4):81-87
Han NY, Kim JY, Kim MJ, Park BJ, Sung DJ, Sim KC, ve ark. Validation of Feasibility of Magnetic Resonance Imaging for the Measurement of Depth of Tumor Invasion in Distal Bile Duct Cancer According to the New American Joint Committee on Cancer Staging System. Acad Radiol. 2017 Dec;24(12):1526-1534.
You HS, Hong JW, Yun EY, Kim JJ, Lee JM, Lee SS, ve ark. Primary non-ampullary duodenal adenocarcinoma: a single-center experience for 15 Years. Korean J Gast. 2015 Oct;66(4):194-201.
Struck A, Howard T, Chiorean EG, Clarke JM, Riffenburgh R, Cardenes HR. Non ampullary duodenal adenocarcinoma: factors important for relapse and survival. J Surg Oncol. 2009 Aug 1;100(2):144-8.
Linos DA, Dozois RR, Dahlin DC, Bartholomew LG. Does peutz-jeghers syndrome predispose to gastrointestinal malignancy? A later look. Arch Surg 1981;116:1182-1184.
Guo X, Mao Z, Su D, Jiang Z, Bai L. The clinical pathological features, diagnosis, treatment and prognosis of small intestine primary malignant tumors. Med Oncol 2014;31(4):913.
Dabaja BS, Suki D, Pro B, Bonnen M, Ajani J. Adenocarcinoma of the small bowel: Presentation, prognostic factors, and outcome of 217 patients. Cancer 2004;101:518–26.
Ryder NM, Ko CY, Hines OJ, Gloor B, Reber HA. Primary duodenal adenocarcinoma: A 40- year experience. Arch Surg 2000;135:1070-4.