Laparoscopic fenestration of pancreatic serous cystadenoma: Minimally invasive approach for symptomatic benign disease

Abstract

Serous cystadenoma (SC) is a benign pancreatic cystic tumor. Surgical resection is recommended for symptomatic forms, but laparoscopic fenestration of large symptomatic macrocystic SC was not yet described in the literature. In this study, 3 female patients underwent laparoscopic fenestration for macrocystic SC (12-14 cm). Diagnosis was established via magnetic resonance imaging and endoscopic ultrasound, with intra-cystic dosage of tumors markers (ACE and CA19-9) in 2 patients. All patients were symptomatic and operated on 15-60 mo after diagnosis. Radiological evaluation showed constant cyst growth. Patients were informed about this new surgical modality that can avoid pancreatic resection. The mean operative time was 103 min (70-150 min) with one conversion. The post-operative course was marked by a grade A pancreatic fistula in one patient and was uneventful in the other two. The hospital stay was 3, 10, and 18 d, respectively. The diagnosis of macrocystic SC was histologically-confirmed in all cases. At the last followup (13-26 mo), all patients were symptom-free, and radiological evaluation showed complete disappearance of the cyst. Laparoscopic fenestration, as opposed to resection, should be considered for large symptomatic macrocystic SC, thereby avoiding pancreatic resection morbidity and mortality.

Giant Serous Cystadenoma of the Pancreas (⩾10 cm): The Clinical Features and CT Findings

“…Patients with the portal vein, superior mesenteric vein encasement, or adherence are subjected to vascular resection and reconstruction [ 7 ] or incomplete resection with the blood vessels preservation. Laparoscopic fenestration or dome resection with chemocautery is considered for patients with macrocystic (or oligocystic) type tumors [ 3 , 11 ]. For patients who are ineligible for major operations (e.g., elderly or high-risk individuals), palliative surgery also achieves sound outcome with low mortality and low morbidity [ 4 ] ( Table 1 ).…”

“…Because most of these tumors display benign biological behaviors, asymptomatic patients with small tumors are often recommended for conservative treatment [ 2 ]. Giant pancreatic serous cystadenoma (diameter ≥ 10 cm) is very rare, and only sporadic cases have been reported [ 3 – 11 ]. In this study, we examined the clinical features and CT findings of 6 cases of giant pancreatic serous cystadenoma.…”