Pathologic findings of pancreatoduodenectomy resection specimens : a six-year review of 78 cases at King Hussein Medical Centre

Abstract EN

Objectives: To analyse the different histopathological findings, we encounter in Whipple pancreatoduodenectomy resection specimens in relation to age, gender and the histopathologic parameters of the tumours.

Patients and methods: Data from a case series of consecutive patients who underwent Whipple pancreatoduodenectomy specimen histopathology were retrospectively reviewed and analysed between January 2015 and February 2020.

Results: A total of 78 patients underwent the classical Whipple procedure at King Hussein Medical Centre (KHMC), including 47 males and 31 females (M:F ratio 1.5).

The mean age was 58.6 (19-83) years.

Six patients underwent pancreatoduodenectomy as a treatment for chronic pancreatitis and the remaining 72 patients underwent pancreatoduodenectomy for presumed or proven malignancy by radiological (MDCT/MRI) or by CT-FNA biopsy.

Fifteen patients (19.2%) had benign pancreatic lesions (including the 6 patients underwent pancreatoduodenectomy for chronic pancreatitis) and 63 (80.8%) patients had malignancy in the overall specimen (n=78).

Nine patients (12.5%) had benign pathology and 63 (87.5%) patients had malignancy from the presumed or proven malignancy specimen (n=72).

Patients with benign pathology were more commonly female.

The most common pathologic stage of the tumours was T3 (57.1%).

Regarding tumour differentiation, (76.2%) were moderately differentiated.

Mean tumour size was 3.58 cm.

surgical margins were evaluated in all specimens.

The margin was involved in 11.1% of the specimens.

Perineural invasion present in 76.2% of all specimens while lymphovascular invasion was present in 52.4% of the specimens.

Thirty-three (52.4%) specimens showed lymph node metastasis.

Conclusion: Several factors need to be evaluated during the histopathologic assessment of surgical specimen of pancreatoduodenectomy (Whipple resection), these factors include the histopathologic type of the tumour, the size of the tumour, tumour extension, tumour location, surgical margin status, lymphovascular or perineural invasion, and lymph node status.

The need for more thorough and accurate assessments of the evolution of patients with suspected malignant lesions, in particular earlier diagnosis and management as most of the patients diagnosed at advanced stages.

Number of involved lymph nodes by metastasis and lymph node ratio should be considered in final pathological reports due to high prognostic value.

Benign pathology in a presumed malignancy should be considered in a resected specimen even with radiological signs suggestive of malignancy