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Background <p>Differentiating between pancreatic cancer (PC) and benign pancreatic lesions is challenging, leading to misdiagnosis and unnecessary pancreatoduodenectomy (PD). This systematic review and meta-analysis aimed to determine the prevalence of PC misdiagnosis in PD.</p> Methods <p>A systematic review was conducted following PRISMA guidelines&#xa0;and was prospectively registered on PROSPERO (CRD42024510669). We included 21 studies comprising 13,660 patients who underwent PD for suspected malignancy. A random-effects meta-analysis&#xa0;with 95% confidence interval&#xa0;(CI) was used to calculate the pooled prevalence of misdiagnosis&#xa0;and risk ratios of surgical complications or clinical manifestations.</p> Results <p>The pooled prevalence of misdiagnosed cancer cases was 8.35% (95% CI: 7.26–9.59). Chronic pancreatitis was the most common benign condition mistaken for cancer, with a pooled prevalence of 40.69% (95% CI 28.47–58.15). The most frequently reported preoperative symptoms included abdominal pain (62.54%), jaundice (52.05%), and weight loss (52.71%). Misdiagnosis was associated with abdominal pain as a clinical presentation, whereas jaundice was more common in malignancy (OR 2.21, 95% CI 1.15–4.24). Malignant pathology was associated with higher risks of postoperative pancreatic fistula (RR 2.01, 95% CI 1.18–3.43) and mortality (RR 2.57, 95% CI 1.06–6.24). Misdiagnoses were more prevalent among younger male patients, with females comprising 39.86% (95% CI 31.18–46.48) of the cohort.</p> Discussion <p>Pancreatic cancer misdiagnosis leading to surgical intervention remains a prevalent condition, with young male patients without weight loss being the most affected population and chronic pancreatitis the major differential diagnosis. </p>

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Misdiagnosis of Suspected Cancer in Pancreatoduodenectomy: A Systematic Review and Prevalence Mata-Analysis

  • 期刊论文

  • 发表日期：

    2025年11月14日

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  • Luis F. Leite da Siva,
  • Luiz F. Costa de Almeida,
  • Marcos Belotto,
  • Jose M. Ramia-Angel

摘要

Background

Differentiating between pancreatic cancer (PC) and benign pancreatic lesions is challenging, leading to misdiagnosis and unnecessary pancreatoduodenectomy (PD). This systematic review and meta-analysis aimed to determine the prevalence of PC misdiagnosis in PD.

Methods

A systematic review was conducted following PRISMA guidelines and was prospectively registered on PROSPERO (CRD42024510669). We included 21 studies comprising 13,660 patients who underwent PD for suspected malignancy. A random-effects meta-analysis with 95% confidence interval (CI) was used to calculate the pooled prevalence of misdiagnosis and risk ratios of surgical complications or clinical manifestations.

Results

The pooled prevalence of misdiagnosed cancer cases was 8.35% (95% CI: 7.26–9.59). Chronic pancreatitis was the most common benign condition mistaken for cancer, with a pooled prevalence of 40.69% (95% CI 28.47–58.15). The most frequently reported preoperative symptoms included abdominal pain (62.54%), jaundice (52.05%), and weight loss (52.71%). Misdiagnosis was associated with abdominal pain as a clinical presentation, whereas jaundice was more common in malignancy (OR 2.21, 95% CI 1.15–4.24). Malignant pathology was associated with higher risks of postoperative pancreatic fistula (RR 2.01, 95% CI 1.18–3.43) and mortality (RR 2.57, 95% CI 1.06–6.24). Misdiagnoses were more prevalent among younger male patients, with females comprising 39.86% (95% CI 31.18–46.48) of the cohort.

Discussion

Pancreatic cancer misdiagnosis leading to surgical intervention remains a prevalent condition, with young male patients without weight loss being the most affected population and chronic pancreatitis the major differential diagnosis.