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Cystic lesions of the pancreas—is radical surgery really warranted?

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Abstract

Purpose

The purpose of this study was to retrospectively evaluate diagnostic accuracy of cystic lesions of the pancreas in order to determine if less aggressive surgical treatment might be safe and therefore warranted.

Methods

A retrospective cohort study was conducted in 232 patients with either observed or resected cystic lesions of the pancreas referred for evaluation and treatment to the University Medical Center Freiburg, Germany, between 2001 and 2011.

Results

Most patients had MRI or CT for preoperative imaging (90.6 %). Preoperatively, benign pseudocysts (BPC) were diagnosed in 84 (36.2 %) patients and intraductal papillary mucinous neoplasm (IPMN) in 59 (25.2 %) patients, whereas serous cyst adenoma, mucinous cystic neoplasm (MCN), solid pseudopapillary tumors (SPPTs), and neuroendocrine tumors (NETs) were less common. In 43 % of patients, the preoperative diagnosis concurred with the postoperative diagnosis. The preoperative diagnosis was accurate in BPC, less so in IPMN, and inaccurate in MCN, NET, and SPPT. However, prediction of tumor biology was accurate; only 11 % of the lesions regarded as benign turned out to be malignant after resection, and no patient without resection developed malignancy at a median follow-up of 8 months. Subsequently, 89 % of diagnosed benign tumors had indeed benign pathology.

Conclusions

The prediction of biology is often correct, whereas specific diagnosis is often wrong. A considerable amount of benign lesions are treated more aggressively than warranted if malignancy is suspected prior to surgery. Parenchyma-sparing techniques might be an option, but prospective multicenter studies need to follow. Experienced pancreatic radiologists can improve accuracy of preoperative biology.

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Authors’ contributions

Kim C Honselmann: Analysis and interpretation of data and drafting of manuscript.

Tobias Krauss: Study conception and design and critical revision of manuscript.

Sebastian Geserick: Acquisition of data.

Ulrich F Wellner: Critical revision of manuscript and analysis of data.

Uwe Wittel: Critical revision of manuscript.

Ulrich T. Hopt: Critical revision of manuscript.

Tobias Keck: Critical revision of manuscript.

Dirk Bausch: Study conception and design and critical revision of manuscript.

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Authors and Affiliations

  1. Department of Surgery, University Medical Center Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23538, Luebeck, Germany

    Kim C. Honselmann, Ulrich F. Wellner, Tobias Keck & Dirk Bausch

  2. Department of Radiology, University Medical Center Freiburg, Freiburg im Breisgau, Germany

    Tobias Krauss

  3. Department of Surgery, University of Freiburg, Freiburg im Breisgau, Germany

    Sebastian Geserick, Uwe Wittel & Ulrich T. Hopt

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  1. Kim C. Honselmann
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Correspondence to Dirk Bausch.

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Funding

This study was not funded.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

This article does not contain any studies with animals performed by any of the authors.

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The authors received no financial support.

Additional information

Kim C. Honselmann and Tobias Krauss contributed equally to the manuscript.

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Honselmann, K.C., Krauss, T., Geserick, S. et al. Cystic lesions of the pancreas—is radical surgery really warranted?. Langenbecks Arch Surg 401, 449–456 (2016). https://doi.org/10.1007/s00423-016-1416-1

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  • DOI: https://doi.org/10.1007/s00423-016-1416-1

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