Surgical treatment of cystic neoplasms of the pancreas

Abstract

-Context -Diagnosis and treatment of cystic neoplasms of the pancreas increased significantly in the last decades. There are only a few Brazilian publications on these tumors. The majority of them are limited to reports of one or few cases. Objective -To present our experience with 27 patients with cystic neoplasms of the pancreas. Methods -Demographic data, clinical manifestations, diagnostic exams, surgical procedures, postoperative complications, and follow-up data of 27 patients with cystic neoplasms of the pancreas were analyzed, according to the histological type of the tumor. Results -There were 10 (37%) serous cystic tumors, 10 (37%) mucinous cystic tumors, 4 (15%) intraductal papillary mucinous tumors, and 3 (11%) solid pseudopapillary tumors or Frantz tumor. All serous cystic tumors, 6 (60%) mucinous tumors, 2 (50%) intraductal papillary mucinous tumors, and 2 (67%) solid pseudopapillary tumors were benign. The age of the patients varied from 31 to 82 years and all tumors were more common in female. Two patients had been treated previously as a pseudocyst. Surgical procedures depended on the location and extension of the tumor. Two patients underwent only laparotomy with tumor biopsy, one cholecystectomy with Roux-en-Y hepaticojejunostomy for jaundice treatment, 6 pancreatoduodenectomy, and 18 partial pancreatectomy. The most common postoperative complication was pancreatic fistula (n = 5; 19%). One patient died of necrotic pancreatitis. Of the 10 patients with serous cystic tumor, only 1 had tumor recurrence at the section border. The three patients with mucinous cystoadenocarcinoma in which was not possible to resect the tumor, died 6 to 24 months after laparotomy. The six patients with benign mucinous tumors did not have tumor recurrence. Conclusions -The most common cystic neoplasms of the pancreas are serous and mucinous cysts. These tumors are more frequent in female. Although almost all serous cysts are benign, 40% of mucinous cysts are malign. Misdiagnosis may delay appropriate treatment and increase mortality.

Surgical Management of Cystic Lesions of the Pancreas: A Single-Centre Experience

“…Usually, the Frantz's tumor is 10 times more frequent in women (9) . Regarding the clinical presentation of patients at diagnosis, the majority (89.7%) were symptomatic, differently from what has been reported in other series with 40% to 75% of cases being asymptomatic (2)(3)(4)7,9) ; it is very likely that this was due to the fact that all individuals of this series underwent surgery and thus the surgical indication biased the results. Therefore, the majority of the individuals in the current series due presented large-volume lesions diagnosed after causing mass effect and consequently abdominal pain, nausea, vomiting, weight loss and abdominal distension.…”

“…However, a much lower prevalence is found when analyzing only pancreatic neoplastic cystic lesions (1% to 10% of pancreatic neoplasms). These, despite their rarity, account for about 30% of pancreatic resections (2,3,(5)(6)(7)(8)(9) . The incidence of CLPs is increasing (2), mainly due to advances in imaging technology and increased access to computed tomography (CT) and magnetic resonance imaging (MRI).…”

“…In Brazil, recent publications on CLPs are limited to literature reviews, case series and reports (6,7) . This study aims to describe the cases of CLPs which underwent surgical intervention at a tertiary university hospital.…”

Surgical resection and outcome of pancreatic cystic neoplasms in China: analysis of a 16-year experience from a single high-volume academic institution

“…Coelho et al . [13] reported in 2010 that only 4 (15%) patients were diagnosed IPMN, and in a series of 599 consecutive patients, Bassi et al . [14] found an IPMN rate of 17%.…”

“…Surgical intervention generally depends on the location and size of the tumor [13]. Tumors of the head and uncinate process should be treated with pancreatoduodenectomy.…”