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A Journal on Surgery
Indexed/Abstracted in: EMBASE, Scopus, Emerging Sources Citation Index
Chirurgia 1999 February;12(1):1-6
Current guidelines in the diagnosis and staging of pancreatic neoplasms
Proposito D., Santoro R., Lazzaro M., Mancini B., Gallina S., Carboni M.
Background. The aim of this article is to define the role of staging in the surgical treatment of pancreatic neoplasms. A diagnostic algorithm, based on new technologic advances and on personal experience, is worked out in order to improve resectability and prognosis assessment.
Methods. Personal experience two-hundred-ninety-four patients with pancreatic cancer, observed during the years 1959-1995 is reported. Evaluation of diagnostic technique application, divided by ten-year periods, proved to be interesting. During the years 1959-1970, diagnosis was carried out by means of upper gastrointestinal X-ray series and cholecystography, modalities that disappeared during the 1981-1995 period, in which, as a result of the introduction of ultrasonography, CT and ERCP, these techniques were used with percentages of 64.2, 78.5 and 23.8%, respectively.
Results. Moreover, technologic advances influenced metastasis diagnosis, which distinctly increased during the years 1981-1995. Infact, liver metastases were detected in 21/119 patients (17.6%) in the 1959-1970 period vs 44/126 patients (34.9%) during the years 1981-1995, while assessment of vessel invasion was obtained respectively in 4/119 patients (3.3%) vs 37/126 patients (29.3%), a statistically significant difference. Staging of exocrine pancreatic carcinoma is not only indispensable for standardizing patient selection, but is necessary for evaluating outcome of effected treatments and for comparing them properly. The stage of cancer should accurately reflect the prognosis of patients. Nevertheless, comparing stage classification (SC) for carcinoma of the pancreas recommended by UICC with that of Japanese Pancreas Society (JPS-SC), these are quite different. Infact, N-factor is perhaps overestimated in UICC-SC, which reveals the tendency to classify the patients in a less advanced stage than in JPS-SC. Japanese stage classification is more detailed, considering many factors.
Conclusions. The most significant indicator for survival is the spread to retroperitoneal peripancreatic tissues (Rp-factor JPS). JPS classification, though more complex, better relates to prognosis than UICC staging system.