Treatment Strategy for a Pancreatic Cystic Neoplasm.
- Author:
Seok Jin NAM
1
;
Dae Kyum KIM
;
Sang Ik NOH
;
Jin Seok HEO
;
Jae Hyung NOH
;
Tae Sung SOHN
;
Sung Joo KIM
;
Seong Ho CHOI
;
Jae Won JOH
;
Yong Il KIM
Author Information
1. Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
- Publication Type:Original Article
- Keywords:
Cystic neoplasm;
Pancreatic neoplasm;
Treatment
- MeSH:
Adenoma, Islet Cell;
Alcohol Drinking;
Carcinoma, Papillary;
Cystadenoma, Serous;
Diagnosis, Differential;
Dilatation, Pathologic;
Female;
Humans;
Mortality;
Mucins;
Pancreatic Cyst*;
Pancreatic Neoplasms;
Pathology;
Retrospective Studies;
Risk Factors
- From:Journal of the Korean Surgical Society
2000;59(5):658-666
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
PURPOSE: Cystic pancreatic neoplasms are rare, but interesting, because of their high cure rate. With the exception of pseudocysts and serous cystadenomas, which are always benign, these cystic neoplasms are either premalignant or malignant. However, there is no reliable clinical criteria for differential diagnosis, and the treatment plan may be confusing. METHODS: From October 1994 to November 1999, 60 cases, diagnosed as a cystic neoplasm preoperatively were reviewed retrospectively. The clinical findings of benign lesions (benign group) and those for malignant or premalignant tumors (malignant group) were compared. RESULTS: The postoperative pathology results indicate 10 serous cystadenomas, 13 mucinous cystic neoplasms, 11 solid and papillary neoplasms, 10 duct ectasias, 2 cystic islet cell tumors, 1 metastatic papillary carcinoma, 1 lymphepithelial cyst, 2 simple cysts, 6 pseudocysts, and 4 retension cysts without malignancy. The mean age of the patients was 48.6 years, and the male-to-female ratio was 5 to 7. The accuracy of CT for diagnosing the malignancy of malignant tumors was 37.8% (14/37) and that of US was 22.2% (4/18). The rate of tumors having malignant potential was 71.7% (37/60). The mean size of the tumors in the benign group was smaller than that in the malignant group (p=0.014). There was a higher proportion of females in the malignant group than in the benign group (p=0.001). Heavy alcohol consumption was found more frequently in the benign group (p=0.021). There were no differences in the other clinical findings. The mortality rate of the operations was 0%, and the morbidity rate was 18%. CONCLUSION: Since it is difficult to determine the precise tumor type of a cystic pancreatic neoplasm preoperatively, all these lesions should be treated with surgical resection in order to identify and remove the malignant or premalignant neoplasms early. However, if the operative risk is high, malignant risk factors having large sized tumor, especially more than 6 cm, female, and having no history of heavy alcohol consumption may be useful for deciding the treatment plan.
