Mucinous cystic neoplasm of the pancreas: Is surgical resection recommended for all surgically fit patients?

Background and Study Aims. Endoscopic ultrasound (EUS) surveillance of patients with mucinous pancreatic cysts relies on the assessment of morphologic features suggestive of malignant transformation. These criteria were derived from the evaluation of surgical pathology in patients with pancreatic cysts who underwent surgery. Reliability of these criteria when evaluated by EUS in identifying lesions which require surgery has still not been established. Patients and Methods. This retrospective cohort study included seventy-eight patients who underwent surgical resection of pancreatic cysts based on EUS-FNA (fine-needle aspiration) findings suggestive of mucinous pancreatic cysts with concern for malignancy. Results. Final surgical pathology diagnoses of patients were the following: adenocarcinoma (19), intraductal papillary mucinous neoplasm (IPMN) (39), mucinous cystic neoplasm (MCN) (13), serous cystadenoma (2), pseudocyst (3), mucinous solid-cystic lesion of indeterminate type (1), and mesenteric cyst (1). Cysts with focal wall thickening ≥ 3 mm (p=0.0008), dilation of pancreatic duct (PD) (p=0.0067), and cyst size ≥ 3 cm (p=0.016) had significantly higher risk of adenocarcinoma. None of the patients without any of these morphologic features had cancer. Conclusions. In patients with mucinous pancreatic cyst(s), focal wall thickening, cyst size ≥ 3 cm, and PD dilation as assessed by EUS can help identify advanced mucinous cysts which require surgery and should routinely be evaluated during EUS surveillance.

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Surgical resection of mucinous cystic neoplasm which showed increase and decrease in size over 30-months follow-up: A case report

Suizo ◽

10.2958/suizo.34.262 ◽

2019 ◽

Vol 34 (5) ◽

pp. 262-269

Author(s):

Makoto TAKAHASHI ◽

Takashi HATORI ◽

Tomohisa KADOMURA ◽

Atsushi KATO ◽

Yoshifumi IKEDA ◽

...

Keyword(s):

Case Report ◽

Surgical Resection ◽

Mucinous Cystic Neoplasm ◽

Cystic Neoplasm

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The Pathological Features and Prognoses of Intraductal Papillary Mucinous Neoplasm and Mucinous Cystic Neoplasm After Surgical Resection: A Single Institution Series

10.21203/rs.3.rs-63560/v1 ◽

2020 ◽

Author(s):

Yuqiong Li ◽

Zhongfei Zhu ◽

Lisi Peng ◽

Zhendong Jin ◽

Liqi Sun ◽

...

Keyword(s):

Surgical Resection ◽

Mucinous Cystic Neoplasm ◽

Cystic Neoplasm ◽

Study Cohort ◽

Single Institution ◽

Cystic Neoplasms ◽

Mucinous Neoplasms ◽

Transformation Potential ◽

Independent Risk Factors

Abstract Background: Intraductal papillary mucinous neoplasms (IPMNs) and mucinous cystic neoplasms (MCNs) represent the tumors with malignant transformation potential. The objective of the study was to verify their pathological characteristics, prognoses, and recurrence factors. Methods: 218 IPMNs and 27 MCNs resected at a single institution were included. The demographic, preoperative, histopathological and follow-up data of the patients were recorded and analyzed. Results: Of the 218 IPMN and 27 MCN patients, 93 (42.7%) and 8 (29.6 %) cases were malignant, respectively. IPMNs occurred in older patients compared with MCN patients (median 63 years vs 54 years, P<0.0001) and MCNs occurred exclusively in females (100%). Of the overall study cohort, the pathological specimens presented peripheral invasion in 37 (15.1%) patients and incisal margin invasion was observed in 46 (18.8%) patients. After a median follow-up of 34 months, 37(14.9%) patients relapsed. The 1, 3, 5 -year overall survival rate (OS) and diseases-free survival (DFS) rate for IPMNs were 98.75%, 98.75%, 97.5%, and 85.7%, 81.1%, 80.6%; and for MCNs the rates were 95.7%, 95.7%, 95.7%, and 91.3%%, 87.0%, 87.0%, respectively. There were four independent risk factors associated with recurrence: pathological diagnoses with malignancy (Odds rate, OR=3.65), presence of oncocytic type for IPMN (OR=1.69), peripheral invasion (OR=12.87) and incisal margin invasion (OR=1.99). Conclusions: IPMNs and MCNs are indolent tumors with favorable prognoses after surgical resection in terms of their relatively high OS and DFS rate. Patients with malignant pathological-related diagnoses should accept strict tumor surveillance in view of their higher risk of recurrence.

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The pathological features and prognoses of intraductal papillary mucinous neoplasm and mucinous cystic neoplasm after surgical resection: a single institution series

World Journal of Surgical Oncology ◽

10.1186/s12957-020-02063-8 ◽

2020 ◽

Vol 18 (1) ◽

Author(s):

Yuqiong Li ◽

Zhongfei Zhu ◽

Lisi Peng ◽

Zhendong Jin ◽

Liqi Sun ◽

...

Keyword(s):

Surgical Resection ◽

Disease Free Survival ◽

Mucinous Cystic Neoplasm ◽

Cystic Neoplasm ◽

Study Cohort ◽

Single Institution ◽

Cystic Neoplasms ◽

Initial Surgery ◽

Transformation Potential

Abstract Background Intraductal papillary mucinous neoplasms (IPMNs) and mucinous cystic neoplasms (MCNs) represent the tumors with malignant transformation potential. The objective of the study was to verify their pathological characteristics, prognoses, and recurrence factors. Methods Two hundred eighteen IPMNs and 27 MCNs resected at a single institution were included. The demographic, preoperative, histopathological, and follow-up data of the patients were recorded and analyzed. Overall survival (OS) and disease-free survival (DFS) were defined as the interval from the date of initial surgery to death or the last follow-up (OS) and to diagnosis of recurrence or death at follow-up (DFS). Results Of the 218 IPMN and 27 MCN patients, 93 (42.7%) and 8 (29.6%) cases were malignant, respectively. IPMNs occurred in older patients compared with MCN patients (median 63 years vs 54 years, P < 0.0001), and MCNs occurred exclusively in females (100%). Of the overall study cohort, the pathological specimens presented peripheral invasion in 37 (15.1%) patients and incisal margin invasion was observed in 46 (18.8%) patients. After a median follow-up of 34 months, 37 (14.9%) patients relapsed. The 5-year OS and DFS rates of IPMNs were 97.5% and 80.6%; and the OS and DFS rates of MCNs were 95.7% and 87.0%, respectively. There were four independent risk factors associated with recurrence: pathological diagnoses with malignancy (odds ratio, OR = 3.65), presence of oncocytic type for IPMN (OR = 1.69), peripheral invasion (OR = 12.87), and incisal margin invasion (OR = 1.99). Conclusions IPMNs and MCNs are indolent tumors with favorable prognoses after surgical resection in terms of their relatively high OS and DFS rate. Patients with malignant pathological-related diagnoses should accept strict tumor surveillance in view of their higher risk of recurrence.

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The pathological features and prognoses of intraductal papillary mucinous neoplasm and mucinous cystic neoplasm after surgical resection: a single institution series

10.21203/rs.3.rs-63560/v2 ◽

2020 ◽

Author(s):

Yuqiong Li ◽

Zhongfei Zhu ◽

Lisi Peng ◽

Zhendong Jin ◽

Liqi Sun ◽

...

Keyword(s):

Surgical Resection ◽

Disease Free Survival ◽

Mucinous Cystic Neoplasm ◽

Cystic Neoplasm ◽

Study Cohort ◽

Single Institution ◽

Cystic Neoplasms ◽

Initial Surgery ◽

Transformation Potential

Abstract Background: Intraductal papillary mucinous neoplasms (IPMNs) and mucinous cystic neoplasms (MCNs) represent the tumors with malignant transformation potential. The objective of the study was to verify their pathological characteristics, prognoses, and recurrence factors.Methods: 218 IPMNs and 27 MCNs resected at a single institution were included. The demographic, preoperative, histopathological and follow-up data of the patients were recorded and analyzed. Overall survival (OS) and disease-free survival (DFS) were defined as the interval from the date of initial surgery to death or the last follow up (OS) and to diagnosis of recurrence or death at follow-up (DFS).Results: Of the 218 IPMN and 27 MCN patients, 93 (42.7%) and 8 (29.6 %) cases were malignant, respectively. IPMNs occurred in older patients compared with MCN patients (median 63 years vs 54 years, P<0.0001) and MCNs occurred exclusively in females (100%). Of the overall study cohort, the pathological specimens presented peripheral invasion in 37 (15.1%) patients and incisal margin invasion was observed in 46 (18.8%) patients. After a median follow-up of 34 months, 37(14.9%) patients relapsed. The 5-year OS and DFS rate of IPMNs were 97.5% and 80.6%; and the OS and DFS rates of MCNs were 95.7% and 87.0%, respectively. There were four independent risk factors associated with recurrence: pathological diagnoses with malignancy (Odds ratio, OR=3.65), presence of oncocytic type for IPMN (OR=1.69), peripheral invasion (OR=12.87) and incisal margin invasion (OR=1.99).Conclusions: IPMNs and MCNs are indolent tumors with favorable prognoses after surgical resection in terms of their relatively high OS and DFS rate. Patients with malignant pathological-related diagnoses should accept strict tumor surveillance in view of their higher risk of recurrence.

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