Management of Pancreatic Cystic Neoplasms: Single Institutional Study

Sallam, Ahmad N.; Faltas, Kerollous M. F.; Abokoura, Sameh; Badawy, Mohammad T.; Abu-elela, Khaled A.; Abdeldayem, Hesham

doi:10.21608/ejsur.2024.336510.1279

Management of Pancreatic Cystic Neoplasms: Single Institutional Study

Document Type : Original Article

Authors

¹ Departments of HPB Surgery, National Liver Institute, Menoufia University, Menoufia, Egypt

² Department of HPB Surgery and Liver Transplantation, Egypt Air Hospital, Cairo, Egypt

³ Departments of Diagnostic and Intervention Radiology, National Liver Institute, Menoufia University, Menoufia, Egypt

10.21608/ejsur.2024.336510.1279

Abstract

Background: The term “pancreatic cystic neoplasms” refers to a heterogeneous group of pancreatic cysts that have
different clinical, radiological, and pathological characteristics. These include intraductal papillary mucinous neoplasms
(IPMN), mucinous cystic neoplasms, serous cystic neoplasms, and solid pseudopapillary neoplasms.
Patients and Methods: This is a retrospective study from January 2006 to September 2022 that involved 50 patients
who proved to have pancreatic cystic lesions. Patient preoperative laboratory results, computed tomography (CT), MRI
with magnetic resonance cholangiopancreatography and endoscopic ultrasound (EUS) with cystic fluid analysis findings,
postoperative pathological findings, types of resection and postoperative morbidity, such as pancreatic leak, were all
gathered for study.
Results: Receiver operating characteristic curve is used to show the sensitivity of the investigation in relation to the
pathological outcome. The sensitivity of MRI and EUS in the detection of premalignant pancreatic cystic lesions is more
than CT, with more prognosis, less morbidity, and early detection of premalignant lesions before turning to malignancy.
Also, the results show that the pancreatic leak is less clinically significant with IPMN but with no statistical significance
in relation to other pancreatic cystic lesions.
Management: Pancreatic cystic lesions with malignant potential are treated by close surveillance or surgical excision.
Different types of resection include pancreatico-dudenectomy, distal pancreatectomy, enucleation, and total pancreatectomy.
Conclusion: There is a diagnostic and therapeutic dilemma in the management of pancreatic cystic lesions. The results in
MRI and EUS in relation to the pathological outcome postresection were highly specific and very sensitive in comparison
to the results of dynamic CT. Also, the cytological biomarkers with EUS confirm the diagnosis and have a strong relation
to the pathological diagnosis postresection. The early detection with resection of the premalignant cystic lesion has a good prognosis with less oncological morbidity. Complications postresection are mostly pancreatic leak, which is less clinically significant in IPMN than other cysts without obvious statistical significance.

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