Korean J Hepatobiliary Pancreat Surg.  2011 May;15(2):134-138. 10.14701/kjhbps.2011.15.2.134.

Serous Cystic Neoplasm: Do We Have to Wait Till It Causes Trouble?

• Hwang HK
• Chung YE
• Kim HK
• Park JY
• Choi HJ
• Kang CM
• Lee WJ

• KMID: 1980953
• DOI: http://doi.org/10.14701/kjhbps.2011.15.2.134

Abstract

Serous cystic neoplasm (SCN) of the pancreas is considered a benign tumor with almost no malignant potential. Most surgeons agree that asymptomatic SCN requires only regular observation. However, several complexities and interference with organ preservation during the operation, may develop when a huge symptomatic tumor is treated with surgery. So, the purpose of this study is to develop a potential management plan based on a literature review and by describing three recent cases of SCN of the pancreas. We suggest that SCNs be responded to with a timely and appropriate surgical intervention - before they require clinical attention.

Keyword

Serous cystadenoma; Symptomatic; Surgical treatment

MeSH Terms

Cystadenoma, Serous
Organ Preservation
Pancreas

Figure

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  Fig. 1 (Case 1) A large tumor is compressing the adjacent splenic vein (arrow).

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  Fig. 2 (Case 2) Note dilatation of the distal pancreatic duct (A, arrow) and a huge duodenal ulcer (B, arrow).

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  Fig. 3 (Case 3) An articulating surgical instrument facilitates fine dissection of small tributary vessels between splenic vessels and the distal pancreas (B).

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  Fig. 4 Suggested approach to serous cystic tumor of the pancreas. MIS: minimally invasive surgery, *MIS may be chosen according to the surgeon's preference, experience, and skills.

Reference

1. Becker WF, Welsh RA, Pratt HS. Cystadenoma and cysta denocarcinoma of the pancreas. Ann Surg. 1965; 161:845–863. PMID: 14295937.

2. ReMine SG, Frey D, Rossi RL, Munson JL, Braasch JW. Cystic neoplasms of the pancreas. Arch Surg. 1987; 122:443–446. PMID: 3566528.

3. George DH, Murphy F, Michalski R, Ulmer BG. Serous cystadenocarcinoma of the pancreas: a new entity? Am J Surg Pathol. 1989; 13:61–66. PMID: 2909198.

4. King JC, Ng TT, White SC, Cortina G, Reber HA, Hines OJ. Pancreatic serous cystadenocarcinoma: a case report and review of the literature. J Gastrointest Surg. 2009; 13:1864–1868. PMID: 19459016.

5. Fernández-del Castillo C, Targarona J, Thayer SP, Rattner DW, Brugge WR, Warshaw AL. Incidental pancreatic cysts: clinicopathologic characteristics and comparison with symptomatic patients. Arch Surg. 2003; 138:427–433. PMID: 12686529.

6. Sahani D, Prasad S, Saini S, Mueller P. Cystic pancreatic neoplasms evaluation by CT and magnetic resonance cholangiopancreatography. Gastrointest Endosc Clin N Am. 2002; 12:657–672. PMID: 12607778.

7. Yoon WJ, Lee JK, Lee KH, Ryu JK, Kim YT, Yoon YB. Cystic neoplasms of the exocrine pancreas: an update of a nationwide survey in Korea. Pancreas. 2008; 37:254–258. PMID: 18815545.

8. Birkmeyer JD, Warshaw AL, Finlayson SR, Grove MR, Tosteson AN. Relationship between hospital volume and late survival after pancreaticoduodenectomy. Surgery. 1999; 126:178–183. PMID: 10455881.

9. Strobel O, Z'graggen K, Schmitz-Winnenthal FH, et al. Risk of malignancy in serous cystic neoplasms of the pancreas. Digestion. 2003; 68:24–33. PMID: 12949436.

10. Tseng JF, Warshaw AL, Sahani DV, Lauwers GY, Rattner DW, Fernandez-del Castillo C. Serous cystadenoma of the pancreas: tumor growth rates and recommendations for treatment. Ann Surg. 2005; 242:413–419. PMID: 16135927.

11. Balcom JH 4th, Rattner DW, Warshaw AL, Chang Y, Fernandez-del Castillo C. Ten-year experience with 733 pancreatic resections: changing indications, older patients, and decreasing length of hospitalization. Arch Surg. 2001; 136:391–398. PMID: 11296108.

12. Røsok BI, Marangos IP, Kazaryan AM, et al. Single-centre experience of laparoscopic pancreatic surgery. Br J Surg. 2010; 97:902–909. PMID: 20474000.

13. Giulianotti PC, Sbrana F, Bianco FM, et al. Robot-assisted laparoscopic pancreatic surgery: single-surgeon experience. Surg Endosc. 2010; 24:1646–1657. PMID: 20063016.