Korean J Hepatobiliary Pancreat Surg.  2013 Aug;17(3):118-125. 10.14701/kjhbps.2013.17.3.118.

Surgical management and results for cystic neoplasms of pancreas

Affiliations
  • 1Department of Surgery, Gachon University Gil Medical Center, Incheon, Korea. pyh@gilhospital.com
  • 2Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea.

Abstract

BACKGROUNDS/AIMS
The diagnosis for cystic neoplasm of pancreas is based on the morphologic criteria through imaging studies, but the pre- and postoperative diagnoses are often inconsistent. This study aims at the analysis of clinical characteristics and the results of surgical treatments.
METHODS
A retrospective review was performed on 93 patients who have undergone surgery for pancreatic cystic diseases in our hospital from January 2001 to February 2013. Among them, 69 patients were confirmed as cystic neoplasms based on pathologic findings. Their clinical manifestations, diagnostic accuracy, surgical method and complications, pathologic findings were analyzed.
RESULTS
Serous cystic neoplasm was the most common (n=22), followed by mucinous cystic neoplasm (n=18), intraductal papillary mucinous tumor (n=11), solid pseudopapillary tumor (n=9), neuroendocrine tumor (n=7), and cystic lymphangioma (n=2). The most common clinical symptom is abdominal pains (49.3%). Preoperative imaging studies were consistent with pathological findings in 72% of patients. Cystic fluid CEA levels of 400 ng/ml or more were reliable to detect mucin secreting tumors. Pancreatoduodenectomy was performed for 13 cases and the remaining 54 patients were treated with left-side pancreatectomy. Malignancy was found in 9 cases (13%) of mucin secreting tumors; 5 cases (27.8%) in mucinous cystic neoplasm and 4 cases (36.4%) in intraductal papillary mucinous tumor. Two of these survived without recurrences during the follow-up periods.
CONCLUSIONS
Exact treatment protocols for cystic neoplasm of pancreas are not decided because tumors are found with atypical forms. Surgical management is suggested for resectable tumors because a good prognosis can be expected with proper surgery if precancerous lesions are suspected at the time of discovery.

Keyword

Cystic neoplasm of pancreas; Malignancy; Surgical management

MeSH Terms

Abdominal Pain
Clinical Protocols
Follow-Up Studies
Humans
Lymphangioma, Cystic
Mucins
Neoplasms, Cystic, Mucinous, and Serous
Neuroendocrine Tumors
Pancreas
Pancreatectomy
Pancreatic Cyst
Pancreaticoduodenectomy
Prognosis
Recurrence
Retrospective Studies
Mucins

Reference

1. Brugge WR, Lauwers GY, Sahani D, et al. Cystic neoplasms of the pancreas. N Engl J Med. 2004; 351:1218–1226. PMID: 15371579.
Article
2. Le Borgne J, de Calan L, Partensky C. Cystadenomas and cystadenocarcinomas of the pancreas: a multiinstitutional retrospective study of 398 cases. French surgical association. Ann Surg. 1999; 230:152–161. PMID: 10450728.
3. Galanis C, Zamani A, Cameron JL, et al. Resected serous cystic neoplasms of the pancreas: a review of 158 patients with recommendations for treatment. J Gastrointest Surg. 2007; 11:820–826. PMID: 17440789.
Article
4. Matsumoto T, Hirano S, Yada K, et al. Malignant serous cystic neoplasm of the pancreas: report of a case and review of the literature. J Clin Gastroenterol. 2005; 39:253–256. PMID: 15718870.
5. Jeurnink SM, Vleggaar FP, Siersema PD. Overview of the clinical problem: facts and current issues of mucinous cystic neoplasms of the pancreas. Dig Liver Dis. 2008; 40:837–846. PMID: 18499541.
Article
6. Park KH, Kim SG, Moon DB, et al. Clinical analysis of surgical management for cystic neoplasms of pancreas. Korean J Hepatobiliary Pancreat Surg. 2000; 4:177–187.
7. Sarr MG, Carpenter HA, Prabhakar LP, et al. Clinical and pathologic correlation of 84 mucinous cystic neoplasms of the pancreas: can one reliably differentiate benign from malignant (or premalignant) neoplasms? Ann Surg. 2000; 231:205–212. PMID: 10674612.
8. Wilentz RE, Albores-Saavedra J, Zahurak M, et al. Pathologic examination accurately predicts prognosis in mucinous cystic neoplasms of the pancreas. Am J Surg Pathol. 1999; 23:1320–1327. PMID: 10555000.
Article
9. Bernard P, Scoazec JY, Joubert M, et al. Intraductal papillary-mucinous tumors of the pancreas: predictive criteria of malignancy according to pathological examination of 53 cases. Arch Surg. 2002; 137:1274–1278. PMID: 12413317.
Article
10. Kobari M, Egawa S, Shibuya K, et al. Intraductal papillary mucinous tumors of the pancreas comprise 2 clinical subtypes: differences in clinical characteristics and surgical management. Arch Surg. 1999; 134:1131–1136. PMID: 10522860.
11. Jang JY, Kim SW, Ahn YJ, et al. Multicenter analysis of clinicopathologic features of intraductal papillary mucinous tumor of the pancreas: is it possible to predict the malignancy before surgery? Ann Surg Oncol. 2005; 12:124–132. PMID: 15827792.
Article
12. Kamisawa T, Fujiwara T, Tu Y, et al. Long-term follow-up of intraductal papillary adenoma of the pancreas. J Gastroenterol. 2002; 37:868–873. PMID: 12424574.
Article
13. Jang JY, Kim SW, Lee SE, et al. Treatment guidelines for branch duct type intraductal papillary mucinous neoplasms of the pancreas: when can we operate or observe? Ann Surg Oncol. 2008; 15:199–205. PMID: 17909912.
Article
14. Kucera JN, Kucera S, Perrin SD, et al. Cystic lesions of the pancreas: radiologic-endosonographic correlation. Radiographics. 2012; 32:E283–E301. PMID: 23150863.
Article
15. van der Waaij LA, van Dullemen HM, Porte RJ. Cyst fluid analysis in the differential diagnosis of pancreatic cystic lesions: a pooled analysis. Gastrointest Endosc. 2005; 62:383–389. PMID: 16111956.
Article
16. Linder JD, Geenen JE, Catalano MF. Cyst fluid analysis obtained by EUS-guided FNA in the evaluation of discrete cystic neoplasms of the pancreas: a prospective single-center experience. Gastrointest Endosc. 2006; 64:697–702. PMID: 17055859.
Article
17. Thornton GD, McPhail MJ, Nayagam S, et al. Endoscopic ultrasound guided fine needle aspiration for the diagnosis of pancreatic cystic neoplasms: a meta-analysis. Pancreatology. 2013; 13:48–57. PMID: 23395570.
Article
18. Spinelli KS, Fromwiller TE, Daniel RA, et al. Cystic pancreatic neoplasms: observe or operate. Ann Surg. 2004; 239:651–657. PMID: 15082969.
19. Lee CJ, Scheiman J, Anderson MA, et al. Risk of malignancy in resected cystic tumors of the pancreas < or =3 cm in size: is it safe to observe asymptomatic patients? A multi-institutional report. J Gastrointest Surg. 2008; 12:234–242. PMID: 18040749.
20. Ko YH, Han DJ, Lee SG, et al. A clinical study on cystic neoplasms of the pancreas. Korean J Gastroenterol. 2003; 41:49–58.
21. Weber SM, Cho CS, Merchant N, et al. Laparoscopic left pancreatectomy: complication risk score correlates with morbidity and risk for pancreatic fistula. Ann Surg Oncol. 2009; 16:2825–2833. PMID: 19609621.
Article
22. Nakamura Y, Uchida E, Nomura T, et al. Laparoscopic pancreatic resection: some benefits of evolving surgical techniques. J Hepatobiliary Pancreat Surg. 2009; 16:741–748. PMID: 19585074.
Article
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