An aggressive resectional approach to cystic neoplasms of the pancreas

BACKGROUND: Prognosis is good after curative resection for serous and mucin ous cystic neoplasms of the pancreas. There has been a recent trend to rese ct all cystic neoplasms, without attempts to preoperatively determine the e xact histologic subtype. Our purpose is to report on the results of such an aggressive surgical approach to all cystic neoplasms of the pancreas. METHODS: This is a retrospective cohort analysis of 25 patients with cystic neoplasms of the pancreas treated between July 1991 and July 1998. Data in clude patient demographics, presenting symptom, operative procedure, pathol ogic diagnosis, periop morbidity and mortality, survival, and symptomatic f ollow-up data. RESULTS: Twenty-one patients were women, with a mean age of 60 for the enti re cohort. Mean follow-up was 24 months (range 6 months to 4.3 years) with complete follow-up possible in 92%. Twenty-three patients had curative rese ctions and 2 had palliative resections. One patient with an uncinate mass h ad a partial pancreatectomy; 4 patients underwent distal pancreatectomy and 9 had distal pancreatectomy with splenectomy; 11 patients required a pancr eatoduodenectomy, and of these, 4 had tumors involving the portal vein, nec essitating a portal Vein resection. Pathologic analysis revealed 12 serous cystadenomas, 4 mucinous cystadenomas, 3 mucinous cystadenocarcinomas, 5 in traductal papillary cystic neoplasms, and 1 serous cystadenocarcinoma. The overall perioperative complication rate was 40% with 5 major and 5 minor co mplications. In the 11 pancreatoduodenectomy patients alone, there were 1 m ajor and 4 minor complications. There were no pancreatic fistulas or portal vein thromboses and no operative mortalities. Two patients, both with muci nous cystadenocarcinomas, died of their disease at 6 and 16 months postoper atively. All 11 pancreatoduodenectomy patients have only mild pancreatic in sufficiency relieved by daily enzyme replacement. CONCLUSIONS: The good outcomes in this study support an aggressive surgical approach to all patients diagnosed with a cystic neoplasm of the pancreas, if medically fit to tolerate surgery. This approach is justified for the f ollowing reasons: (1) preoperative differentiation of a benign versus malig nant tumor is unreliable and routine testing for this purpose is of questio nable utility; (2) potential adverse consequences of nonresectional therapy are significant; (3) perioperative morbidity and mortality of pancreatic s urgery is low; and (4) prognosis with curative resection is good. (C) 1999 by Excerpta Medica, Inc.