• M G Keane, A Shamali, L N Nilsson, A Antila, J Millastre Bocos, M Marijinissen Van Zanten, C Verdejo Gil, P Maisonneuve, Y Vaalavuo, T Hoskins, S Robinson, G O Ceyhan, M Abu Hilal, S P Pereira, J Laukkarinen, and M Del Chiaro.
• Institute for Liver and Digestive Health, University College London, London.
• Br J Surg. 2018 Mar 1; 105 (4): 439-446.

BackgroundPancreatic mucinous cystic neoplasms (MCNs) are rare mucin-producing cystic tumours defined by the presence of ovarian-type stroma. MCNs have a malignant potential and thus surgery is frequently performed. The aim of this cohort study was to define better the criteria for surgical resection in patients with MCN.MethodsThis multicentre retrospective study included all resected MCNs between 2003 and 2015 in participating centres. Lesions without ovarian-type stroma were excluded. Patient characteristics, preoperative findings, histopathology findings and follow-up data were recorded.ResultsThe study included 211 patients; their median age was 53 (range 18-82) years, and 202 (95·7 per cent) were women. Median preoperative tumour size was 55 (range 12-230) mm. Thirty-four of the 211 (16·1 per cent) were malignant, and high-grade dysplasia (HGD) was found in a further 13 (6·2 per cent). One-third of MCNs in men were associated with invasive cancer, compared with 15·3 per cent in women. Five cases of malignant transformation occurred in MCNs smaller than 4 cm. All cases of malignancy or HGD were associated with symptoms or features of concern on preoperative cross-sectional imaging. In multivariable analysis, raised carbohydrate antigen 19-9 (odds ratio (OR) 10·54, 95 per cent c.i. 2·85 to 218·23; P < 0·001), tumour size (OR 4·23, 3·02 to 11·03; P = 0·001), mural nodules (OR 3·55, 1·31 to 20·55; P = 0·002) and weight loss (OR 3·40, 2·34 to 12·34; P = 0·034) were independent factors predictive of malignant transformation.ConclusionsSmall indeterminate MCNs with no symptoms or features of concern may safely be observed as they have a low risk of malignant transformation.© 2018 BJS Society Ltd Published by John Wiley & Sons Ltd.

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