Cystic neoplasms of pancreas: Long-Term Outcomes With Surgical Therapy

Hiromichi Ito, Evan Matros, Stanley W Ashley, Michael J Zinner, Edward E Whang
Brigham and Women's Hospital, Boston, MA

Objective: The aims of this study were to evaluate outcomes associated with the surgical management of cystic neoplasms of pancreas and to determine clinico-pathological factors associated with malignant histology.
Design:Retrospective case series.
Setting:Tertiary academic medical center.
Patients:109 patients with pancreatic cystic neoplasm were treated surgically. Mean patient age was 54 years, and 78% were female.
Main Outcome Measures:Survival was analyzed using the Kaplan-Meier method and Log-Rank test. Median follow-up was 32 months (0-150 months).
Results:Of the 109 patients, 45 had a mucinous cystic neoplasm (MCN), 30 had an intraductal papillary mucinous neoplasm (IPMN) and 17 had a serous cystic neoplasm (SCN). Invasive cancer was found in 22%, 23% and 0% of MCN, IPMN, and SCN, respectively. The presence of invasive foci was associated with older patient age (62 years vs. 53 years, p=0.03) but not with tumor size, or presence of symptoms. 5 of 17 patients with invasive foci developed tumor recurrence, whereas none of the patients without invasion developed recurrence. The overall 5-year survival rates of patients with MCN, IPMN and SCN were 86%, 90% and 94%, respectively. The corresponding survival rates of patients with MCN and IPMN with invasive foci were 41% and 56%, respectively.
Conclusions:The presence of invasive foci in pancreatic cystic neoplasms, associated with recurrence and poor survival, remains difficult to predict preoperatively.

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