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Variant anatomy of the biliary system as a cause of pancreatic and peri-ampullary cancers
- Source :
- HPB. 22:1675-1685
- Publication Year :
- 2020
- Publisher :
- Elsevier BV, 2020.
-
Abstract
- 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.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, seen10% 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(p0.0001). Intra-pancreatic type low-union was seen in 16% of PACs versus 2% of controls(p0.0001).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.
- Subjects :
- Ampulla of Vater
Pathology
medicine.medical_specialty
Common Bile Duct Neoplasms
Peri
Early detection
03 medical and health sciences
0302 clinical medicine
Duodenal Neoplasms
medicine
Pancreatic border
Humans
Hepatology
business.industry
Gastroenterology
Pancreatic Neoplasms
Bile Ducts, Intrahepatic
medicine.anatomical_structure
Bile Duct Neoplasms
Common hepatic duct
030220 oncology & carcinogenesis
Cystic duct
030211 gastroenterology & hepatology
Pancreas Cancers
Pancreas
business
Subjects
Details
- ISSN :
- 1365182X
- Volume :
- 22
- Database :
- OpenAIRE
- Journal :
- HPB
- Accession number :
- edsair.doi.dedup.....ca69cc27ab463a30d2da0300defc0f7f