• Annals of surgery · Dec 2022

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

    • Giovanni Marchegiani, Andrea Caravati, Stefano Andrianello, Tommaso Pollini, Giulia Bernardi, Marco Biancotto, Giuseppe Malleo, Claudio Bassi, and Roberto Salvia.
    • Department of Surgery, Verona University Hospital Trust, Verona, Italy.
    • Ann. Surg. 2022 Dec 1; 276 (6): e868e875e868-e875.

    ObjectiveOur aim is to provide a real-life picture of serous cystic neoplasms (SCNs) management once a presumptive diagnosis is made.Summary Of Background DataSCNs of the pancreas are invariably benign entities. While consensus about their management is lacking, surgical resection still plays a role.MethodsPresumed 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.ResultsA 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.ConclusionsIn 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.Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

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