Background: Pancreatic carcinoma has a poor prognosis. It is important to focus on early detection and treatment for improvement of the prognosis. Understanding the characteristics of TS1 pancreatic carcinoma (≤2 cm) could improve the treatment outcome of pancreatic carcinoma. Methods: Among 444 patients with conventional pancreatic carcinoma who underwent surgery at our facility, the study targeted 65 (14.6%) with a histopathological diagnosis of TS1 pancreatic carcinoma. We examined 65 cases of TS1 pancreatic carcinoma in reason for hospital visit, examination findings, histopathological findings, and treatment outcomes. Results: The detection rate of TS1 pancreatic carcinoma by ultrasonography was 83.1% for visualization of the tumor mass and 96.9% for main pancreatic duct dilatation. The corresponding rates for endoscopic ultrasound were 92.9% and 100%. With regard to postoperative outcome, 43.1% of patients had a recurrence; the site of recurrence was local in 24.6% and hepatic in 9.2%. On multivariate analysis, intrapancreatic neural invasion was an independent risk factor for recurrence (odds ratio, 6.333; 95% confidence interval, 1.834 - 21.872; p = 0.004). Conclusions: To screen for TS1 pancreatic carcinoma, the study first examined for main pancreatic duct dilatation by ultrasonography and then conducted a detailed examination with endoscopic ultrasound. Patients with pancreatic neural invasion require careful attention for local recurrence.
Egawa, S., Toma, H., Ohigashi, H., Okusaka, T., Nakao, A., Hatori, T., et al. (2012) Japan Pancreatic Cancer Registry; 30th Year Anniversary: Japan Pancreas Society. Pancreas, 41, 985-992. https://doi.org/10.1097/MPA.0b013e318258055c
Tsunoda, T., Yamamoto, Y., Kimoto, M., Imai, H., Iwamoto, S., Kawasaki, S., et al. (1998) Staging and Treatment for Patients with Pancreatic Cancer. How Small Is an Early Pancreatic Cancer? Journal of Hepato-Biliary-Pancreatic Surgery, 5, 128-132. https://doi.org/10.1007/s005340050022
Batabyal, P., Vander, Hoorn, S., Christophi, C. and Nikfarjam, M. (2014) Association of Diabetes Mellitus and Pancreatic Adenocarcinoma: A Meta-Analysis of 88 Studies. Annals of Surgical Oncology, 21, 2453-2462. https://doi.org/10.1245/s10434-014-3625-6
Larsson, S.C., Permert, J., Hakansson, N., Naslund, I., Bergkvist, L. and Wolk, A. (2005) Overall Obesity, Abdominal Adiposity, Diabetes and Cigarette Smoking in Relation to the Risk of Pancreatic Cancer in Two Swedish Population-Based Cohorts. British Journal of Cancer, 93, 1310-1315. https://doi.org/10.1038/sj.bjc.6602868
Bang, U.C., Benfield, T., Hyldstrup, L., Bendtsen, F. and Beck Jensen, J.E. (2014) Mortality, Cancer, and Comorbidities Associated with Chronic Pancreatitis: A Danish Nationwide Matched-Cohort Study. Gastroenterology, 146, 989-994. https://doi.org/10.1053/j.gastro.2013.12.033
Lowenfels, A.B., Maisonneuve, P., Cavallini, G., Ammann, R.W., Lankisch, P.G., Andersen, J.R., et al. (1993) Pancreatitis and the Risk of Pancreatic Cancer. International Pancreatitis Study Group. The New England Journal of Medicine, 328, 1433-1437. https://doi.org/10.1056/NEJM199305203282001
Tanaka, S., Nakao, M., Ioka, T., Takakura, R., Takano, Y., Tsukuma, H., et al. (2010) Slight Dilatation of the Main Pancreatic Duct and Presence of Pancreatic Cysts as Predictive Signs of Pancreatic Cancer: A Prospective Study. Radiology, 254, 965-972. https://doi.org/10.1148/radiol.09090992
Yoon, S.H., Lee, J.M., Cho, J.Y., Kyung, B.L., Ji, E.K., Seung, K.M., et al. (2011) Small (≤ 20 mm) Pancreatic Adenocarcinomas: Analysis of Enhancement Patterns and Secondary Signs with Multiphasic Multidetector CT. Radiology, 259, 442-452. https://doi.org/10.1148/radiol.11101133
Duffy, M.J., Sturgeon, C., Lamerz, R., Haglund, C., Holubec, V.L., Klapdor, R., et al. (2010) Tumor Markers in Pancreatic Cancer: A European Group on Tumor Markers (EGTM) Status Report. Annals of Oncology, 21, 441-447. https://doi.org/10.1093/annonc/mdp332
Goonetilleke, K.S. and Siriwardena, A.K. (2007) Systematic Review of Carbohydrate Antigen (CA 19-9) as a Biochemical Marker in the Diagnosis of Pancreatic Cancer. European Journal of Surgical Oncology, 33, 266-270. https://doi.org/10.1016/j.ejso.2006.10.004
Yu, J., Li, A., Hong, S.M., Hruban, R.H. and Goggins, M. (2012) MicroRNA Alterations of Pancreatic Intraepithelial Neoplasias. Clinical Cancer Research, 18, 981-992. https://doi.org/10.1158/1078-0432.CCR-11-2347
Kojima, M., Sudo, H., Kawauchi, J., Takizawa, S., Kondou, S., Nobumasa, H., et al. (2015) MicroRNA Markers for the Diagnosis of Pancreatic and Biliary-Tract Cancers. PloS ONE, 10, e0118220. https://doi.org/10.1371/journal.pone.0118220
Maguchi, H. (2004) The Roles of Endoscopic Ultrasonography in the Diagnosis of Pancreatic Tumors. Journal of Hepato-Biliary-Pancreatic Surgery, 11, 1-3. https://doi.org/10.1007/s00534-002-0752-4
Yamao, K., Sawaki, A., Mizuno, N., Shimizu, Y., Yatabe, Y. and Koshikawa, T. (2005) Endoscopic Ultrasound-Guided Fine-Needle Aspiration Biopsy (EUS-FNAB): Past, Present, and Future. Journal of Gastroenterology, 40, 1013-1023. https://doi.org/10.1007/s00535-005-1717-6
Fisher, L., Segarajasingam, D.S., Stewart, C., Deboer, W.B. and Yusoff, I.F. (2009) Endoscopic Ultrasound Guided Fine Needle Aspiration of Solid Pancreatic Lesions: Performance and Outcomes. Journal of Gastroenterology and Hepatology, 24, 90-96. https://doi.org/10.1111/j.1440-1746.2008.05569.x
Yamao, K., Ohashi, K., Mizutani, S., et al. (1998) Endoscopic Ultrasound-Guided Fine-Needle Aspiration (EUS-FNA) for the Diagnosis of Digestive Diseases. Endoscopy, 30, A176-A178. https://doi.org/10.1055/s-2007-1001513
Wakatsuki, T., Irisawa, A., Bhutani, M.S., Hikichi, T., Shibukawa, G., Takagi, T., et al. (2005) Comparative Study of Diagnostic Value of Cytologic Sampling by Endoscopic Ultrasonography-Guided Fine-Needle Aspiration and That by Endoscopic Retrograde Pancreatography for the Management of Pancreatic Mass without Biliary Stricture. Journal of Gastroenterology and Hepatology, 20, 1707-1711. https://doi.org/10.1111/j.1440-1746.2005.03900.x
Han, S.S., Jang, J.Y., Kim, S.W., Kim, W.H., Lee, K.U. and Park, Y.H. (2006) Analysis of Long-Term Survivors after Surgical Resection for Pancreatic Cancer. Pancreas, 32, 271-275. https://doi.org/10.1097/01.mpa.0000202953.87740.93
Sperti, C., Pasquali, C., Piccoli, A. and Pedrazzoli, S. (1997) Recurrence after Resection for Ductal Adenocarcinoma of the Pancreas. World Journal of Surgery, 21, 195-200. https://doi.org/10.1007/s002689900215
Griffin, J.F., Smalley, S.R., Jewell, W., Paradelo, J.C., Reymond, R.D., Hassanein, R.E., et al. (1990) Patterns of Failure after Curative Resection of Pancreatic Carcinoma. Cancer, 66, 56-61. https://doi.org/10.1002/1097-0142(19900701)66:1 3.0.CO;2-6
Kayahara, M., Nagakawa, T., Ueno, K., Ohta, T., Takeda, T. and Miyazaki, I. (1993) An Evaluation of Radical Resection for Pancreatic Cancer Based on the Mode of Recurrence as Determined by Autopsy and Diagnostic Imaging. Cancer, 72, 2118-2123. https://doi.org/10.1002/1097-0142(19931001)72:7 3.0.CO;2-4
Westerdahl, J., Andren-Sandberg, A. and Ihse, I. (1993) Recurrence of Exocrine Pancreatic Cancer—Local or Hepatic? Hepatogastroenterology, 40, 384-387.
Matsuno, S., Egawa, S., Fukuyama, S., Fuyuhiko, M., Makoto, S., Shuji, I., et al. (2004) Pancreatic Cancer Registry in Japan: 20 Years of Experience. Pancreas, 28, 219-230. https://doi.org/10.1097/00006676-200404000-00002
Luttges, J., Schemm, S., Vogel, I., Hedderich, J., Kremer, B. and Kloppel, G. (2000) The Grade of Pancreatic Ductal Carcinoma Is an Independent Prognostic Factor and Is Superior to the Immunohistochemical Assessment of Proliferation. The Journal of Pathology, 191, 154-161. https://doi.org/10.1002/(SICI)1096-9896(200006)191:2 3.0.CO;2-C
Neoptolemos, J.P., Stocken, D.D., Dunn, J.A., et al. (2001) Influence of Resection Margins on Survival for Patients with Pancreatic Cancer Treated by Adjuvant Chemoradiation and/or Chemotherapy in the ESPAC-1 Randomized Controlled Trial. Annals of Surgery, 234, 758-768. https://doi.org/10.1097/00000658-200112000-00007