Diagnosis and treatment of pancreatic cystic neoplasms: clinical analysis of 126 cases

Abstract

Objective To summerize our experience in the diagnosis and treatment of pancreatic cystic neoplasms.Methods A retrospective analysis was conducted on the clinical data of 126 patients with pancreatic cystic neoplasms seen between January 2003 and December 2012 in the Fuzhou General Hospital.Results There was no special clinical manifestation in this series of 126 patients with pancreatic cystic neoplasms.The diagnostic accuracies of ultrasound,CT and MRI were 90.8％ (109/120),93.4％ (114/122) and 96.3％ (103/107) respectively.Eighteen and ten patients were observed to have elevated serum CA19 9 and CEA respectively.One hundred and five patients received conventional open surgery,while 21 patients underwent laparoscopic operations.The operations in cluded enucleation of tumor (n=11),pancreatic segment resection (n=5),spleen preserving distal pancreatectomy (n=30),distal pancreatectomy (n=26),duodenum-preserving pancreatic head resection (n=4),pylorus-preserving Whipple resection (n=5),Whipple procedure (n=38),total pancre atectomy (n=2) and exploratory laparotomy and biopsy (n=5).The perioperative mortality rate was 0.8％ (1/126).Pancreatic fistula (B and C) occurred in 16 patients (12.7％,16/126),and postoperative hemorrhage (B and C) occurred in 9 patients (7.1％,9/126).One hundred and fourteen patients were followed up from 6 to 72 months (median 52.4 months).The five-year survival rates for all the pancreatic cystic neoplasms,non-invasive and invasive neoplasms were 80.5％,96.4％ and 40.7％ respectively.Conclusions Pancreatic cystic neoplasms are a rare subset of pancreatic tumor,being increasingly detected due to the widespread use of abdominal imaging and improved imaging techniques.Most of them are benign,but some are malignant or they have malignant transformation and metastatic potential.Patients with asymptomatic benign pancreatic cystic neoplasms,especially small size,are candidates for observation.Patients with clinical symptoms or having a high suspicion of malignancy should be offered surgical resection.Non-invasive neoplasms should receive pancreatic preserving operations.Pancreatectomy plus regional lymph nodes dissection with or without combined resection of adjacent multi organs should be adopted for invasive neoplasms. Key words: Pancreatic neoplasms; Surgical procedures, operative