Incidence and reasons of pancreatic resection in patients with asymptomatic serous cystadenoma

Despite diagnostic refinements, pancreatic resection (PR) is eventually performed in some patients with asymptomatic serous cystadenoma (A-SCA). The aim of this study was to define incidence and reasons of PR in A-SCA. A retrospective analysis of a prospectively maintained database was performed for...

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Published in:Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.] 2018-07, Vol.18 (5), p.577-584
Main Authors: Lombardo, Carlo, Iacopi, Sara, Menonna, Francesca, Napoli, Niccolò, Kauffmann, Emanuele, Bernardini, Juri, Cacciato Insilla, Andrea, Boraschi, Piero, Donati, Francescamaria, Cappelli, Carla, Campani, Daniela, Caramella, Davide, Boggi, Ugo
Format: Article
Language:English
Subjects:
Atrophy
Computed tomography
Cysts
Diagnostic error
Incidental pancreatic cystic lesions
Magnetic resonance imaging
Management of pancreatic cystic lesions
Medical diagnosis
Medical imaging
NMR
Nodules
Nuclear magnetic resonance
Pancreas
Pancreatic resection
Pancreatic serous cystadenoma
Patients
Positron emission tomography
Solid tumors
Streptococcus infections
Surgery
Ultrasonic imaging
Ultrasound
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Summary:Despite diagnostic refinements, pancreatic resection (PR) is eventually performed in some patients with asymptomatic serous cystadenoma (A-SCA). The aim of this study was to define incidence and reasons of PR in A-SCA. A retrospective analysis of a prospectively maintained database was performed for all the patients referred for pancreatic cystic lesions (PCL) between January 2005 and March 2016. Overall, there were 1488 patients with PCL, including 1271 (85.4%) with incidental PCL (I-PCL). During the study period referral of I-PCL increased 8.5-fold. Surgery was immediately advised in 94 I-PCL (7.3%) and became necessary later on in 11 additional patients (0.9%), because of the development of symptoms. Overall, PR was performed in 105/1271 patients presenting with I-PCL (8.2%), including 27 with A-SCA (2.1%). All patients with A-SCA underwent ultrasonography and contrast-enhanced computed tomography. Magnetic resonance imaging was performed in 21 patients (77.8%), 18 F-FDG positron emission tomography in 8 (29.6%), endoscopic ultrasonography (EUS) in 2 (7.4%), and EUS-guided fine needle aspiration (EUS-FNA) in 1 (3.7%). These studies demonstrated a combination of atypical features such as solid tumor (3; 11.1%), oligo-/macrocystic tumor (24; 88.8%), mural nodules (14; 51.8%), enhancing cyst walls (17; 62.9%), dilation of the main pancreatic duct (3; 11.1%), and upstream pancreatic atrophy (1; 3.7%). Additionally, 14/27 patients (51.8%) were females with oligo-/macrocystic tumors located in the body-tail of the pancreas. Management of patients with A-SCA entails a small risk of PR especially when these tumors demonstrate atypical radiologic features associated with confounding anatomic and demographic characteristics.
ISSN:1424-3903
1424-3911
DOI:10.1016/j.pan.2018.06.001