Endoscopic vs surgical cystogastrostomy in patients with pancreatic pseudocyst: A comparative study

Abstract

Introduction: Intraductal papillary mucinous neoplasms (IPMN) are considered precursor lesions to pancreatic adenocarcinoma. The risk of malignancy is increased in main duct/mixed type IPMNs but even with modern imaging it may be challenging to accurately diagnose main pancreatic duct involvement. The objective of this study was to determine how well radiological findings correlate with pathological features of IPMNs. Methods: Consecutive cases of IPMN undergoing pancreatic resection at our unit were reviewed. All patients' radiological images and histological slides were retrieved and re-evaluated. Radiologists and pathologists performed independent blinded assessments of the tumors. Results: Twenty-two cases of IPMN were identified with a median age was 65 years. Male to female ratio was 10:12. The diagnosis of IPMN was preoperatively suspected in 82% of cases based on radiological evaluation. The surgical procedures performed included pancreaticoduodenectomy (n = 20), total pancreatectomy (n = 1) and distal pancreatectomy (n = 1). An invasive IPMN component was seen in 55% of the specimens on histopathological evaluation. Radiological accuracy was 45% for detecting involvement of the main pancreatic duct. Seven of the patients (32%) had a second malignancy within the tumor specimen, including ampullary adenocarcinoma in 3 patients, duodenal adenocarcinoma in 2 patients, cholangiocarcinoma in 1 patient and anaplastic pancreatic cancer in 1 patient. Conclusion: Preoperative radiological assessment is fairly accurate in diagnosing IPMN, however it frequently underestimates main pancreatic duct involvement, which may question the validity of basing surgical decisions on radiological assessment of duct engagement. IPMN is often associated with a secondary periampullary malignancy.

Drenaje de los pseudoquistes pancreáticos: endoscópico vs quirúrgico metaanálisis. ¿Es momento de la hibridación?

“…No deja claro qué técnicas se emplearon para seleccionar a los pacientes que irían a una y otra modalidad de tratamiento y no reporta la recurrencia ni el costo de estancia intrahospitalaria. 24 En México Saúl y colaboradores realizaron un estudio retrospectivo en el Instituto Nacional de Nutrición, donde se evaluaron 64 procedimientos en 61 pacientes, 21 de forma endoscópica, 43 con manejo quirúrgico, en 16 de los 21 realizados de forma endoscópica (76%) el drenaje fue realizado transgástrico y en cinco (24%) fueron transduodenales. El éxito terapéutico se logró en 90.5% de los pacientes del grupo endoscópico y en 90.7% de los pacientes quirúrgicos (p = 0.7) con una prevalencia de complicaciones de 23.8 y 25.6% respectivamente (p = 0.8) y una mortalidad de 0 a 2.3 para cada grupo (p = 0.4).…”