Diagnosis and treatment of pancreatic cystic neoplasms

Abstract

Objective To investigate the clinical features, diagnosis and treatment of pancreatic cystic neoplasms. Methods The clinical data of 62 patients with pancreatic cystic neoplasms who were admitted to the First Affiliated Hospital of Anhui Medical University from January 2010 to December 2014 were retrospectively analyzed. Benign neoplasms included benign mucinous cystic neoplasm (MCN) , serous cystic neoplasm (SCN) , solid pesudopapillary neoplasm (SPN) and intraductal papillary mucinous neoplasm (IPMN) and malignant neoplasms included borderline or malignant MCN and borderline or malignant IPMN. The sex, age, clinical symptoms, imaging features, laboratory results, surgical method, operation time, volume of intraoperative blood loss, perioperative complications, result of pathological examination and follow-up were analyzed. Patients were followed up by telephone interview and outpatient examination up to 31, December 2014 or death．Measurement data with normal distribution were presented by±s, while measurement data with non-normal distribution were presented by M (range). Univariate analysis of count data was done by chi-square test or Fisher exact probability. Multivariate analysis was done by Logistic regression model. Results Of the 62 patients with pancreatic cystic neoplasms, 31 were retreated due to upper digestive discomfort, 10 without specific features were found during the health examinations, 10 due to weight loss in near 2-3 months, 9 due to abdominal masses and 2 due to obstructive jaundice.Results of radiographic examinations showed that the diameter of the tumor is (60 ±35) mm, 11 of tumors located in the head and neck of pancreas and 51 located in the body and tail of pancreas.The cystic nodule or solid ingredients were detected in 33 patients and main pancreatic duct dilation in 6 patients.The positive diagnostic rates of B ultrasound, computed tomography (CT) , magnetic resonance imaging (MRI) , and endoscopic ultrasonography (EUS) and positron emission tomography-computed tomography (PET/ CT) were 85.5% (53/ 62) , 93.2% (55/ 59) , 94.1% (16/ 17) , 100.0% (3/ 3) and 100.0% (2/ 2) .Preoperative serum CEA and serum CA19-9 were 1.22 μg/ L(0.20-12.98 μg/ L) and 10.85 U/ mL (0.60-1 000.00 U/ mL) , while the percentage of patients with increasing CEA and CA19-9 were 4.8% (3/ 62) and 14.5% (9/ 62) , respectively.All the 62 patients received surgery, distal pancreatectomy (DP) combined with splenectomy were performed on 36 patients, pancreatoduodenectomy on 10 patients, partial pancreatic resection on 7 patients, spleen-preserving DP on 6 patients, cyst-resection on 2 patients and palliative Roux-en-Y anastomosis on 1 patient.The rate of surgical resection, operation time and volume of blood loss were 98.4% (61/ 62) , (219 ± 79) minutes and (299 ± 296) mL.After operation, 13 patients had different degrees of complication, and were improved by symptomatic treatment such as jejunitas, hemostasis and anti-infection.The results of pathological examination showed that 27 patients were with MCN (11 with malignant or borderline MCN) , 18 with SCN, 11 with SPN and 6 with IPMN (3 with malignant or borderline IPMN) .All the patients were followed up for 3-63 months with good prognoses, except for the death of 2 patients.The results of univariate analysis showed that age of onset, tumor diameter, preoperative serum CEA and preoperative serum CA19-9 were related factors affecting diagnosis of malignant tumor (χ2=18.798, 12.335, 7.281, 10.073, P <0.05 ) .The results of multivariate analysis showed that age≥65 years and preoperative serum CA19-9≥34.00 U/ mL were independent risk factors affecting diagnosis of malignant tumor ( RR =0.923, 0.994; 95% confidence interval : 0.863-0.987, 0.988-0.999; P <0.05). Conclusions B ultrasound, CT and MRI are the main diagnostic methods for pancreatic cystic neoplasms without specific clinical features.Patients with pancreatic cystic neoplasms have overall good prognosis.The results of multivariate analysis showed that age≥ 65 years and preoperative serum CA19-9≥34.00 U/ mL are independent risk factors affecting tumor malignancy. Key words: Pancreatic cystic neoplasms; Diagnosis; Therapy