Objective-Mucinous cystic neoplasms (MCNs) of the pancreas have often been confused with intraductal papillary mucinous neoplasms. We evaluated the clinicopathologic characteristics, prevalence of cancer, and prognosis of a large series of well-characterized MCNs in 2 tertiary centers.Methods-Analysis of 163 patients with resected MCNs, defined by the presence of ovarian stroma and lack of communication with the main pancreatic duct.Results-MCNs were seen mostly in women (95%) and in the distal pancreas (97%); 25% were incidentally discovered. Symptomatic patients typically had mild abdominal pain, but 9% presented with acute pancreatitis. One hundred eighteen patients (72%) had adenoma, 17 (10.5%) borderline tumors, 9 (5.5%) in situ carcinoma, and 19 (12%) invasive carcinoma. Patients with invasive carcinoma were significantly older than those with noninvasive neoplasms (55 vs. 44 years, P = 0.01). Findings associated with malignancy were presence of nodules (P = 0.0001) and diameter ≥60 mm (P = 0.0001). All neoplasms with cancer were either ≥40 mm in size or had nodules. There was no operative mortality and postoperative morbidity was 49%. Median followup was 57 months (range, 4 -233); only patients with invasive carcinoma had recurrence. The 5-year disease-specific survival for noninvasive MCNs was 100%, and for those with invasive cancer, 57%. Conclusions-This PATIENTS AND METHODSThe MGH and UV Institutional Review Boards approved this study. Patients who underwent pancreatic resection between January 1988 and October 2005 for pathologically confirmed MCNs were identified from prospectively collected databases. Both presence of ovarian stroma and lack of communication with the main pancreatic duct were used as criterion to distinguish MCNs from IPMNs. 2,4 In the study period, 567 patients underwent surgery for mucinous tumors of the pancreas (305 MGH and 262 UV). Of these 163 (29%), 102 from UV and 61 from MGH, were determined to have MCNs, whereas the remaining patients had main-duct, branch-duct, or combined IPMNs, or indeterminate mucinous neoplasms. Information including demographics, clinical history, diagnostic work-up, type of surgery, postoperative course, pathology, and long-term follow-up were recorded. Perioperative mortality was defined as in-hospital or 30-day death.Tumors were classified according to the WHO criteria as MCNs with mild dysplasia (adenoma), with moderate dysplasia (borderline neoplasm), with high-grade dysplasia (carcinoma in situ), and MCN with invasive carcinoma. 4 In short, in MCN adenoma, the epithelium shows basally located nuclei with no increase in mitosis. In the borderline MCNs, the epithelium may exhibit papillary projections or crypt-like invagination, some nuclear pseudostratification with crowding and slightly enlarged nuclei. Mitoses can be observed. MCN with noninvasive carcinoma demonstrate high-grade dysplastic epithelial changes. The epithelium often forms papillae and irregular budding, as well as branching with nuclear stratification, severe nuclear a...

BACKGROUND & AIMS Mucin-producing neoplasms (MPNs) of the pancreas include mucinous cystic neoplasms (MCNs) and main-duct, branch-duct, and combined intraductal papillary mucinous neoplasms (IPMNs). MCNs and branch-duct IPMNs are frequently confused; it is unclear whether main-duct, combined, and branch-duct IPMNs are a different spectrum of the same disease. We evaluated their clinical and epidemiologic characteristics. METHODS Patients who underwent resection for histologically confirmed MPNs were identified (N = 557); specimens were reviewed and eventually re-classified. RESULTS One hundred sixty-eight patients (30%) had MCNs, 159 (28.5%) had branch-duct IPMNs, 149 (27%) had combined IPMNs, and 81 (14.5%) had main-duct IPMNs. Patients with MCNs were significantly younger and almost exclusively women; 44% of patients with main-duct or combined IPMNs and 57% of those with branch-duct IPMNs were women. MCNs were single lesions located in the distal pancreas (95%); 11% were invasive. IPMNs were more frequently found in the proximal pancreas; invasive cancer was found in 11%, 42%, and 48% of branch-duct, combined, and main-duct IPMNs, respectively (P =.001). Patients with invasive MCN and those with combined and main-duct IPMNs were older than those with noninvasive tumors. The 5-year disease-specific survival rate approached 100% for patients with noninvasive MPNs. The rates for those with invasive cancer were 58%, 56%, 51%, and 64% for invasive MCNs, branch-duct IPMNs, main-duct IPMNs, and combined IPMNs, respectively. CONCLUSIONS MPNs comprise 3 different neoplasms: MCNs, branch-duct IPMNs, and main-duct IPMNs, including the combined type. These tumors have specific clinical, epidemiologic, and morphologic features that allow a reasonable degree of accuracy in preoperative diagnosis.

After curative resection for AVC, LNR and a cutoff of 16 resected/evaluated nodes are powerful prognostic factors. LNR might represent a major parameter for patient stratification in adjuvant treatment trials.

Main Outcome Measures: Development of a pancreatic fistula (defined as Ͼ30 mL of amylase-rich fluid from drains on or after postoperative day 7, or discharge with surgical drains in place, regardless of amount); the need for additional interventions or total parenteral nutrition; other morbidity; and mortality.Results: Seventy-five patients (12.9%) developed a pancreatic fistula. Fistulas were managed with gradual with-drawal of surgical drains. This allowed for patient discharge and eventual closure at a mean of 18 days in 38.7% of cases; these were classified as low-impact fistulas. The remaining 46 patients (61.3%) had an associated abscess, required percutaneous drainage or total parenteral nutrition, or developed bleeding; these were classified as high-impact fistulas and closed a mean of 35 days after surgery. Standard 30-day in-hospital mortality was 1.9% for all pancreaticoduodenectomies and 6.7% for those who developed a pancreatic fistula. The overall fistula-related mortality was 9.3% (7 patients), all but 1 of which was related to major hemorrhage.Conclusions: More than one-third of pancreatic fistulas are clinically insignificant (low impact). The remaining 60% of fistulas have a high clinical impact and nearly an 8-fold increase in overall mortality.