OPERATIVE MANAGEMENT OF PAPILLARY CYSTIC NEOPLASMS OF THE PANCREAS

Background: Papillary cystic neoplasm (PCN) is a rare malignant tumor of the pancreas that typically occurs in young females and has an exce llent prognosis.Study Design: We report a retrospective review of 12 p atients treated during a 16-year period. Pre-, intra-, and postoperati ve data were evaluated in all patients to determine optimal management with specific reference to surgical strategy. Results: All 12 tumors occurred in young women (mean age 22 years, range 14-36 years). Six pa tients presented with an epigastric mass, and three with severe abdomi nal pain. The correct diagnosis was made preoperatively in only five p atients. Incorrect diagnoses included hepatoma, pancreatic pseudocyst, and hydatid cyst. The PCNs had a mean diameter of 12.5 cm (range 8-20 cm), and occurred in the head (four), neck (three), body (three), and tail (two) of the pancreas. All were resected. Operations performed w ere pylorus-preserving pancreaticoduodenectomy (three), central pancre atectomy with pancreaticogastrostomy (three), distal pancreatectomy (t hree), and local resection (three). In one patient two liver metastase s were resected in addition to the pancreatic primary. One patient pre sented with tumor rupture and a major bleed into the lesser sac and di ed of multiple organ failure after resection. Postoperative complicati ons included a stricture at the hepaticojejunostomy after pancreaticod uodenectomy, which resolved after temporary stenting, and a pancreatic duct fistula after local tumor resection, which required a distal pan createctomy. Eleven patients are well at followup (mean 6.6 years; ran ge 6 months to 15 years). Conclusions: PCN should be considered in the differential diagnosis of large pancreatic masses, especially in youn g females. Conservative resection, where technically feasible, is safe and effective and represents;he therapy of choice. (C) 1998 by the Am erican College of Surgeons.