Serous Cystic Neoplasms of the Pancreas Management in the Real-world: Still Operating on a Benign Entity

• Published in: Annals of surgery Vol. 276; no. 6; pp. e868 - e875
• Main Authors: Marchegiani, Giovanni, Caravati, Andrea, Andrianello, Stefano, Pollini, Tommaso, Bernardi, Giulia, Biancotto, Marco, Malleo, Giuseppe, Bassi, Claudio, Salvia, Roberto
• Format: Journal Article
• Language: English
• Published: United States Lippincott Williams & Wilkins 01-12-2022
• Subjects: Humans; Pancreas - pathology; Pancreatic Neoplasms - diagnosis; Pancreatic Neoplasms - pathology; Pancreatic Neoplasms - surgery
• ISSN: 0003-4932; 1528-1140
• DOI: 10.1097/SLA.0000000000004716

Our aim is to provide a real-life picture of serous cystic neoplasms (SCNs) management once a presumptive diagnosis is made.
SCNs of the pancreas are invariably benign entities. While consensus about their management is lacking, surgical resection still plays a role.
Presumed SCNs evaluated from 1990 to 2018 were included. Indications for surgery, predictors of resection, rate, and predictors of misdiagnosis in the surgical cohort and time trends of management strategies were the main outcomes.
A total of 672 presumed SCNs were included. Presence of symptoms (37%) and large size (34.1%) were the most frequent indications for surgery. Symptoms (60.4% vs 19.0%, P < 0.001), size (45 vs 30 mm, P < 0.001), solid components (19.7% vs 6.2%, P < 0.001), thick walls (14.4 vs 5.6%, P = 0.001) and main pancreatic duct dilation (13.4% vs 5.6%, P = 0.004) were associated with upfront resection (n = 134, 19.9%). Upfront resection decreased over time and 15.4% of patients eventually crossed over to surgery. Increase in size (6.9 vs 1.3 mm/yr), development of symptoms (25.3% vs 3.4%, P < 0.001), solid component (6.0% vs 1.4%, P = 0.010) or jaundice (3.6% vs 0.7%, P = 0.028) were associated with crossing over to surgery. Major morbidity and mortality occurred in 17.1% and 1.7% of patients, respectively. Misdiagnosis occurred mostly in case of macrocystic/unilocular lesions of the body-tail.
In the real-life scenario, SCNs still represent an indication for surgery particularly once large and symptomatic. During surveillance, resection occurs mostly in younger individuals for body/tail lesions. Evidence-based consensus on appropriate indications for surgery is urgently needed.