Experience-based surgical approach to pancreatic mucinous cystic neoplasms with ovarian-type stroma

Kang, Chang Moo; Matsushita, Akira; Hwang, Ho Kyoung; Matsuda, Yoko; Kim, Hyun Ki; Nakamura, Yoshiharu; Lee, Woo Jung

doi:10.3892/ol.2017.7627

Cited by 4 publications

(19 citation statements)

References 39 publications

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“…This finding was not replicated by later studies (11). Studies focusing on the size of cystic neoplasms as a predictor of malignancy report a specificity as low as 46% for a threshold of 4.5 cm (16). In contrast, radiological findings of calcifications, wall thickness and septations can strongly increase the probability of correct radiological diagnosis.…”

Section: Challenges In Preoperative Determination Of Malignancymentioning

confidence: 89%

It’s not all about the size—characteristics and risk factors for malignancy of mucinous cystic neoplasms of the pancreas

Höhn¹,

Soydemir²,

Luu³

et al. 2020

Ann Transl Med

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Background: Mucinous cystic neoplasms (MCN) of the pancreas are rare mucin-producing cystic tumors. As they harbor malignant potential, surgical resection is frequently performed. Current guidelines recommend surgery in asymptomatic patients only for MCN exceeding 4 cm. The aim of this study was to identify radiological and clinical risk factors for malignancy in a single-center cohort of MCN.Methods: All resected MCN from a single high-volume center between 2004 and 2019 were retrospectively analyzed. Patient characteristics, preoperative findings, histopathological results, and data on the postoperative course were recorded. Variables associated with malignancy were evaluated using χ 2 and Mann-Whitney U test. Receiver operating characteristic (ROC) curves were used to model predictive capabilities of preoperative tumor marker levels. Furthermore uni-and multivariate logistic regression analysis were performed for binary variables. Survival time was plotted as Kaplan-Meier curves and evaluated by log-rank test.Results: A total of 63 patients were included. Median age was 62 years; 51 (81.0%) of them were women; median tumor size was 3.5 cm (range, 0.5-18.5); 16 (25.4%) of tumors harbored invasive carcinoma and 13 presented intraepithelial dysplasia (20.6%); 7 (43.8%) invasive carcinomas were smaller than 4 cm. All malignant MCN were radiologically suspected of malignancy (calcifications, mural nodules, or wall thickness) preoperatively. Elevated levels of carbohydrate antigen 19-9 (CA19-9) and carcinoembryonic antigen (CEA) were strongly associated with malignancy (odd's ratio 33.600; 7.000-161.270); P<0.001 and odd's ratio 19.250; 3.370-109.970; P<0.001). Other factors associated with malignancy were preoperative weight loss (P=0.015) and higher age (P=0.048). Tumor size, abdominal or back pain or jaundice showed no significant correlation to malignancy in our cohort.Conclusions: Malignant potential of MCN should not be underestimated and a close clinical and radiological follow-up is mandatory in all suspected cases. This is especially important for small lesions. Risk assessment should not rely only on tumor size but consider all clinical, radiological and laboratory findings of each case. Follow-up should be performed by experienced surgeons and radiologists in high volume centers for pancreatic surgery. Surgery should be performed in all cases in which malignancy is suspected.

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Section: Challenges In Preoperative Determination Of Malignancymentioning

confidence: 89%

It’s not all about the size—characteristics and risk factors for malignancy of mucinous cystic neoplasms of the pancreas

Höhn¹,

Soydemir²,

Luu³

et al. 2020

Ann Transl Med

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“…There is a certain risk of malignancy, since the epithelium of the cyst may undergo progression from adenoma to carcinoma. The original malignancy rates were between 4% and 46%, although the most recent publications lower this figure to 4-12% (1,(6)(7)(8)(9)12,(14)(15)(16)(17)19).…”

Section: Introductionmentioning

confidence: 97%

“…The exponential rise in the number of abdominal radiological tests performed nowadays has increased the diagnosis of pancreatic cystic lesions, many of them asymptomatic (1)(2)(3)(4)(5)(6)(7)(8). In fact, tumors account for only 10-15% of the pancreatic cysts diagnosed.…”

Section: Introductionmentioning

confidence: 99%

“…In fact, tumors account for only 10-15% of the pancreatic cysts diagnosed. These tumors are classified into four large groups: serous cystic neoplasms, mucinous cystic neoplasms (MCN), intraductal papillary mucinous neoplasms (IPMN) and other cystic tumors of the pancreas (1,4,6,9,10).…”

Section: Introductionmentioning

confidence: 99%

“…They were initially described in 1978 as mucin-producing non-ductal cystic tumors (5,11,12), and subsequently divided in 1996 into the two different entities, MCN and IPMN. MCNs were defined as lesions with inner epithelial mucin-secreting cells and a surrounding dense ovarian type stroma (1,3,(6)(7)(8)(12)(13)(14)(15)(16)(17)(18)(19). In 2006, the IAP guidelines added that an MCN could not have communication with the pancreatic duct (1,3,12,14,(16)(17)(18).…”

Section: Introductionmentioning

confidence: 99%

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Pancreatic mucinous cystic neoplasms located in the distal pancreas: a multicenter study

Ramia¹,

Marti²,

Blanco-Fernández³

et al. 2022

Gland Surg

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Background: Mucinous cysts of the pancreas (MCN) are infrequent, usually unilocular tumors which occur in postmenopausal women and are located in the pancreatic body/tail. The risk of malignancy is low.The objective is to define preoperative risk factors of malignancy in pancreatic MCN and to assess the feasibility of the laparoscopic approach.Methods: Retrospective multicenter observational study of prospectively recorded data regarding distal pancreatectomies was carried out at seven hepatopancreatobiliary (HPB) Units between 01/01/08 and 31/12/18 (the ERPANDIS Project).Results: Four hundred and forty-four distal pancreatectomies were recorded including 47 MCN (10.6%).Thirty-five were non-invasive tumors (74.5%). In all, 93% of patients were female, and 60% were ASA (American Society of Anaesthesiology) II. The mean preoperative size was 46 mm. Patients with invasive tumors were older (54 vs. 63 years). Invasive tumors were larger (6 vs. 4 cm), although the difference was not significant (P=0.287). Sixty percent was operated via laparoscopic approach, which was used in 74.6% of noninvasive tumors and in 16.7% of the invasive ones. The spleen was not preserved in 93.6% of the patients. R0 resection was obtained in all patients. Two patients with invasive tumors died.Conclusions: In our surgical series of MCN, patients with malignancy were older and presented larger tumors, although the difference was not statistically significant. Laparoscopy is a safe and feasible approach for MCN. Prospective studies are now needed to define risk factors that can guide the decision whether to administer conservative treatment or to operate.

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Rare tumours of the pancreas: monocentric study

Bauschke,

Altendorf-Hofmann,

Ali-Deeb

et al. 2024

J Cancer Res Clin Oncol

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Purpose The biology of rare pancreatic tumours, which differs from that of ductal pancreatic cancer, requires increased attention. Although the majority of rare pancreatic tumours are benign, it is difficult to decide whether an invasive component exists without complete removal of the lesion, despite considerable progress in diagnosis. We are investigating a large cohort of patients with histologically confirmed epithelial non-ductal non-neuroendocrine neoplasms of the pancreas. Methods Here we analyze long-term survival from patients, who underwent resection of histologically confirmed epithelial non-ductal non-neuroendocrine neoplasms of the pancreas. At our department between Jan 1st, 1999, and Dec 31st, 2019. The median follow-up was 61 (range 0–168) month. All statistical analyses were performed using SPSS 26.0 (IBM, Chicago, IL, USA) software. Results 46 patients (48%) were followed up for more than 5 years, 18 patients (19%) for more than 10 years. The 5-year and 10-year survival rates for rare non-invasive pancreatic tumours were 72% and 55% respectively. The proportion of rare tumour entities (non-ductal and non-neuroendocrine) increased continuously and statistically significantly (p = 0.004) from 4.2 to 12.3% in our clinic between 1999 and 2019. If there is no invasive growth yet, there is a varying risk of malignant degeneration in the course of the disease. Therefore, the indication for pancreatic resection is still the subject of discussion. Conclusion The long-term prognosis of rare epithelial pancreatic tumours after R0 resection—even if they are already malignant—is much better than that of ductal pancreatic cancer.

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Experience-based surgical approach to pancreatic mucinous cystic neoplasms with ovarian-type stroma

Cited by 4 publications

References 39 publications

It’s not all about the size—characteristics and risk factors for malignancy of mucinous cystic neoplasms of the pancreas

It’s not all about the size—characteristics and risk factors for malignancy of mucinous cystic neoplasms of the pancreas

Pancreatic mucinous cystic neoplasms located in the distal pancreas: a multicenter study

Rare tumours of the pancreas: monocentric study

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