Publication: Variant anatomy of the biliary system as a cause of pancreatic and peri-ampullary cancers
Program
KU-Authors
KU Authors
Co-Authors
Muraki, Takashi
Reid, Michelle D.
Pehlivanoglu, Burcin
Gonzalez, Raul S.
Sekhar, Aarti
Memis, Bahar
Xue, Yue
Cheng, Jeanette
Jang, Kee-Taek
Mittal, Pardeep
Advisor
Publication Date
2020
Language
English
Type
Journal Article
Journal Title
Journal ISSN
Volume Title
Abstract
Background: The cause of most pancreatic and periampullary cancers (PAC) is unknown. Recently, anatomic variations such as pancreatobiliary maljunction have been recognized as risk factors, similar to Barrett-related gastro-esophageal cancers. Methods: Pre-operative MRI from 860 pancreatic/biliary resections, including 322 PACs, were evaluated for low-union (cystic duct joining the common hepatic duct inside of the pancreas or within 5 mm of the pancreatic border) Results: Low-union, seen <10% of the population, was present in 44% of PACs (73% distal bile duct/ cholangiocarcinoma, 42% pancreatic head, and 34% ampullary). It was significantly lower(11%) in conditions without connection to the ductal system (thus not exposed to the ductal/biliary tract contents), namely mucinous cystic neoplasms and intrahepatic cholangiocarcinomas(p < 0.0001). Intra-pancreatic type low-union was seen in 16% of PACs versus 2% of controls(p < 0.0001). Discussion: This study establishes an association between low-union and PACs, and points to an anatomy-induced chemical/bilious carcinogenesis. This may explain why most pancreas cancers are in the head. It is possible that the same chemical milieu, caused by conditions other than low-union/insertion, may also play a role in the remaining half of PACs. This opens various treatment opportunities including milieu modifications (chemoprevention), focused screening of at-risk patients, and early detection with possible corrective actions.
Description
Source:
HBP
Publisher:
Elsevier
Keywords:
Subject
Gastroenterology and hepatology, Surgery