Operative Treatment of Cystic Neoplasms of the Pancreas

ABSTRACT

PURPOSE: A cystic neoplasm of the pancreas is a curable tumor if it is removed surgically. The aim of this study was to investigate how two surgical procedures, enucleation of the lesion and pancreatic resection, could be applied based on the anatomic location and size of the tumor. METHODS: The records of 17 patients with a cystic neoplasm of the pancreas who had been treated surgically at the Department of Surgery, Dong-A University Hospital, between November 1990 and March 2000 were reviewed retrospectively. RESULTS: Pathologic diagnoses included 9 solid and papillary epithelial neoplasms (SPEN), 4 serous cystadenomas and 4 mucinous cystadenomas. An enucleation was performed in 4 patients. Two patients had a small cystic neoplasm located on the proximal body of the pancreas. The locations of the neoplasm in the remaining 2 patients were the head in one case and the neck in the other. A pancreatic resection was performed in 13 patients. Three patients had a large cystic neoplasm located on the proximal body of the pancreas. The locations of the neoplasm in the remaining 10 patients were the tail in 5 cases, the distal body in 3 cases, the body and tail in 1 case and the neck and body in 1 case. Major postoperative surgical complications were noticed in 2 patients in each group, respectively two pancreatic abscesses in the resection group, and a pancreatic fistula and a pancreatic abscess each in the enucleation group. They were all managed conservatively by ultrasound-guided needle aspiration and catheter drainage without sequela. Two were lost during follow-up. One patient with a solid and papillary epithelial neoplasm (SPEN) combined with an advanced gastric carcinoma, and died 20 months after the operation because of the recurrence of gastric carcinoma. The other 14 patients were alive without evidence of recurrence during an average follow-up of 48.4 months (range 3-118 months). CONCLUSION: This experience suggests that enucleation of the lesion and pancreatic resection can be performed satisfactorily in patients with cystic neoplasms of the pancreas and that recurrence is not noticed after these operations. Enucleation of the lesion can be performed restrictively for a lesion located on the head or the neck of the pancreas or for a small lesion located on the proximal body of the pancreas.