Cystic pancreatic neoplasms: Enucleate or resect?

Abstract

Asymptomatic cystic pancreatic neoplasms are being detected by abdominal imaging with increasing frequency. Enucleation of small cystic neoplasms can be performed without recurrence but has been associated with a higher incidence of pancreatic fistula. Thus the procedure has been modified to include intraoperative ultrasound imaging and closure of the pancreatic defect. This analysis was performed to determine whether these modifications have improved operative outcome. Thirty patients with mucinous cystic neoplasms (n=16), serous cystadenomas (n=10), and cystic islet cell tumors (n=4) were studied. Enucleation was performed in 11 patients (7 with mucinous cystic neoplasms, 2 with serous cystadenomas and 2 with islet cell tumors), whereas 19 underwent resection of cystic tumors (pancreatoduodenectomy in 8 and distal pancreatectomy in 11). The mean groups did not differ with regard to age (57 years), gender (73% female), presentation (63% incidental), or site (43% head, neck, or uncinate). Patients undergoing enucleation had smaller tumors (2.2 vs. 4.7 cm, P<0.01) that were less likely to be in the tail (9% vs. 42%). Operative time was significantly shorter in the enucleation group (199 vs. 298 minutes, P<0.01). Blood loss also was significantly reduced in the enucleation group (114 vs. 450 ml, P<0.001). Pancreatic fistula rates (27% vs. 26%) and length of hospital stay (12.6 vs. 15.7 days) were similar in the two groups. Enucleation of benign cystic pancreatic neoplasms reduces operative time and blood loss without increasing postoperative complications or length of stay. Therefore enucleation should be the standard operation for small benign cystic neoplasms in the uncinate, head, neck, and body of the pancreas.

Spleen-Preserving Versus Spleen-Sacrificing Distal Pancreatectomy in Laparoscopy and Open Method-Perioperative Outcome Analysis—14 Years Experience

“…Sixty percent of cases in this group were cystic neoplasm. Though in many series of cystic neoplasm of pancreas spleen was not preserved, some series attempted it with favorable outcome [25,26].…”

Pancreatic cysts: etiology, diagnosis and management

“…Authors concluded that enucleation might be safe and effective alternative for patients with benign MCAs. MCAs are also mentioned and cited in Kiely's et al study [90]. Similarly to the SCAs, short-term results of the surgical treatment depend on the pancreatic resection type.…”

“…Simple cystic enucleation (for peripherally located SCAs), in order to preserve pancreatic parenchyma, has been described in the literature. Kiely et al [90] compared enucleation and resection (proximal and distal pancreatectomy) results in 30 patients with mucinous cystic neoplasms (n=16), serous cystadenomas (n=10), and cystic islet cell tumors (n=4). Authors reported significantly shorter operative time in the enucleation group (199 vs. 298 minutes) and significantly reduced blood loss in the enucleation group (114 vs. 450 ml) compared to the resection group.…”

Laparoscopic distal pancreatectomy

“…Distal pancreatectomy with splenic vessel preservation may lead to remnant pancreatic tissue on the splenic vessel, and therefore it is not advised in patients with malignant disease. However, in chronic pancreatitis or benign diseases, the number of cases with spleen preservation is high (33,34). Spleen preservation was shown to be associated with reductions of postoperative infection and length of hospital stay.…”