Evaluation and effectiveness of non surgical treatments in management of symptomatic paraduodenal pancreatitis 

Etude du Club Français du Pancréas

Investigateurs:

Dr Bertrand Napoléon, Hôpital Privé Jean Mermoz

Dr Christelle d’Engremont, CHU Besançon 

Abstract : 

Paraduodenal pancreatitis (PP) is now a well histologically defined entity. However its incidence is poorly known. A surgical series of patients recorded 3.5% of paraduodenal pancreatis among pancreatic resections (Vitali F, pancreas 2014). Chronic panctreatitis is present in 60% of cases (De Pretis N, pancreas 2017).  

The treatment strategy is still poorly codified. In the past, pancreatic surgery was the only option but its morbidity leds to find another effective possibilities. Symptomatic treatments (analgesics, artificial nutrition), somatostatin analogs and endoscopic procedures are available options (Rebours V, Am J Gastroenterol 2007and Arvanitakis M, endoscopy 2014).

The aim of this multicentric retrospective study is to evaluate the therapeutic possibilities and their efficacity in the management of PP. 

Key words : paraduodenal pancreatitis, groove pancreatitis, cystic dystrophy of the duodenal wall 

Methods 

Retrospective study

Multicentric study : 

Investigators and centres: CHU Beaujon (Prof. REBOURS), CHU Besançon (Dr. D’ENGREMONT), CHU Nantes (Dr. LERHUN), Hôpital Privé Mermoz (Dr. NAPOLEON), CHU Marseille (Prof. BARTHET) and IPC (Dr. GIOVANINI), CHU Reims (Dr. DEFOUR), CHU Rouen (Dr. THOMASSIN), CHU Toulouse (Prof. BUSCAIL)

Inclusion criteria: 

• All patients suffering from paraduodenal pancreatitis diagnosed by scan, MRI, echoendoscopy or pathological analysis of surgical specimens
• Symptomatic patients
• Between 2000 and 2020

Data collection:

• Demographic data: date of birth, sex, tobacco and alcohol consumption
• Clinical data: diabetes, pain, weight loss, vomiting, jaundice, haemorrhage, pancreatic exocrine insufficiency
• Morphological data: location of paraduodenal pancreatitis lesions, presence and number of cysts in duodenal wall, lesions of chronic pancreatitis (calcifications, ducts abnormalities, pancreatic atrophy…)
• Therapeutic approaches:
  • - endoscopic treatment (pancreatic stenting, cyst fenestration….), ,
  • - medical treatment: artificial nutrition, pain killers, analogues of somatostatine ….,

Main objective: to assess the efficacy of the treatments (pain relief relapse …)

HOW TO PARTICIPATE Contact us:

cdengremont@chu-besancon.fr

 dr.napoleon@wanadoo.fr

PaRaDis Reference Centre Project

Head of Coordinating Team:

Prof. Vinciane REBOURS (PU-PH) - Deputy Head of Department - Department of Gastroenterology and Pancreatology, Hôpital Beaujon

Chief Investigator:

Dr Lina AGUILERA MUNOZ - Hôpital Beaujon - Service gastro-entérologie et pancréatologie

Investigateurs:

Dr. Lucie LAURENT - Hôpital Beaujon - Department of Gastroenterology and Pancreatology

Prof. Marie Pierre VULLIERME - Hôpital Beaujon - Medical Imaging - Clichy (Centralized review of preoperative images)

Prof. Jerome CROS - Hôpital Beaujon - Anatomy and Pathology - (Centralized review of surgical tissue slides)

Other teams from the Rare Pancreatic Diseases Reference Centre (PaRaDis) who wish to participate.

Logistics: Sandra ROLLET, CRA PaRaDis - Hôpital Beaujon - Department of Gastroenterology and Pancreatology

SUMMARY

Mucinous Cystic Neoplasia (MCN) is a rare pancreatic cyst lesion, but also one of the three precancerous pancreatic conditions. Its natural history is unknown and diagnosis necessarily requires surgical resection.

It is possible that like intraductal papillary mucinous neoplasms of the pancreas, a majority of these cysts could be simply monitored, without systematic recourse to resection, thus avoiding the risks of major and long-term surgery. However, no predictive clinical or morphological criteria have been studied or evaluated to validate such an approach, and experts’ recommendations remain unclear as to the optimal attitude to adopt.

Main objective:

Obtain a predictive score for malignity of mucinous cystadenoma using the clinical and radiological information available at diagnosis. Malignity is defined by at least high-grade dysplasia, distinguished at time of histological analysis of the surgical tissue biopsy.

Secondary objectives:

1. Evaluate overall survival with reference to the grade of dysplasia of the mucinous cystadenoma
2. Assess the degree of post-operative complications

Methodology:

Retrospective multicentric cohort of approximately 300 patients

Inclusion criteria:

1. 1. Patients having undergone surgery for pancreatic mucinous cystadenoma between January 2008 and September 2020 in a participating centre
2. Histologically confirmed mucinous cystadenoma
3. Pre-operative imaging available including TDM and/or MRI

Exclusion criteria :

1. Histological material not available
2. Absence of pre-operative TDM or MRI
3. Patient refusal

Main data to be collected:

Age, sex, blood group ABO, use of tobacco, alcohol, weight and height, diabetes, personal history of pancreatitis, family or personal history of cancer (pancreas), gynaecology and obstetrics history;

CA level of 19.9 at diagnosis

Group ABO

Pre-operative TDM or MRI imaging will undergo centralized review via CD-ROM 

Pathological reports

Post-operative complications: infection, fistula, haemorrhage etc.

Relapse of mucinous cystadenoma

Date of death

Cause of death

Main selection criteria:

• Presence of at least high-grade dysplasia in surgical biopsy tissue (confirmed after second reading)

Selection criteria/secondary assessment:

• Status alive or dead if known at time of biopsy collection.
• Complications, e.g., fistula, infection or haemorrhage post-operatively; i.e., within 30 days of resection

Analytical methods:

Assessment of predictive score for possibility of mucinous cystadenoma with at least high-grade dysplasia; initially, candidate factors will undergo univariate analysis (logistic regression model). Factors with a p-value <0.20 will be included in a multivariate model using a descending model with

p <0.05. The predictive score is derived from the regression coefficients of this multivariate logistic regression model.

How to participate ?

If you wish to participate in data collection for this cohort, please contact:

Dr Lina AGUILERA MUNOZ lina.aguileramunoz@aphp.fr

Sandra ROLLET (ARC) sandra.rollet@aphp.fr ou centre.paradis@aphp.fr Tél : 01 71 11 46 73

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