CYSTIC NEOPLASMS OF THE PANCREAS

Cystic neoplasms of the pancreas are interesting, but rare. We reviewe d the Indiana University experience with these tumors over a 15-year p eriod to study preoperative evaluation and long-term outcome. Twenty-o ne patients (18 females and three males, mean age 59 years) were treat ed between 1977 and 1992. The lesions included mucinous cystic neoplas m-benign (6), mucinous cystic neoplasm-malignant (6), serous cystadeno ma (5), ductal adenocarcinoma with cystic degeneration (2), papillary cystic neoplasm (1), and intra-ductal mucin hypersecreting neoplasm (1 ). The most common symptoms were abdominal pain, back pain, and weight loss. All eight patients with malignant tumors had symptoms; however, only seven of 13 patients with benign lesions had symptoms (P = 0.046 , Fisher exact test). Patients were evaluated with computed tomography of the abdomen (20), endoscopic retrograde cholangiopancreatography ( 12), ultrasound (5), fine needle aspiration (4), and other studies (6) . Six lesions were found incidentally. A correct preoperative diagnosi s was made in only two cases. Operations performed included 14 distal pancreatectomies, five pancreaticoduodenectomies, and one total pancre atectomy. Fifteen of 21 patients are alive and well with follow-up ran ging from 4 months to 16 years. Five deaths occurred in patients with malignant mucinous cystic neoplasms, while only one death occurred in the patients with benign cystic neoplasms. Although computed tomograph y and other diagnostic modalities can identify cystic neoplasms of the pancreas, it is often difficult to make a definitive diagnosis. Becau se all of these lesions except serous cystadenoma are malignant or hav e malignant potential, we feel that cystic neoplasms of the pancreas s hould be treated with aggressive surgical resection in order to identi fy and remove the neoplasm before malignant transformation occurs. Pat ients with premalignant neoplasms have an excellent long term survival , whereas long term survival is rare in patients with malignant neopla sms.