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Serous cystic neoplasm of the pancreas: a multinational study of 2622 patients under the auspices of the International Association of Pancreatology and European Pancreatic Club (European Study Group on Cystic Tumors of the Pancreas)
  1. B Jais1,
  2. V Rebours1,
  3. G Malleo2,
  4. R Salvia2,
  5. M Fontana2,
  6. L Maggino2,
  7. C Bassi2,
  8. R Manfredi2,
  9. R Moran3,4,5,
  10. A M Lennon3,4,5,
  11. A Zaheer3,4,5,
  12. C Wolfgang3,4,5,
  13. R Hruban3,4,5,
  14. G Marchegiani6,
  15. C Fernández Del Castillo6,
  16. W Brugge6,
  17. Y Ha7,
  18. M H Kim7,
  19. D Oh7,
  20. I Hirai8,
  21. W Kimura8,
  22. J Y Jang9,
  23. S W Kim9,
  24. W Jung9,
  25. H Kang10,
  26. S Y Song10,
  27. C M Kang11,
  28. W J Lee11,
  29. S Crippa12,
  30. M Falconi12,
  31. I Gomatos13,
  32. J Neoptolemos13,
  33. A C Milanetto14,
  34. C Sperti14,
  35. C Ricci15,
  36. R Casadei15,
  37. M Bissolati16,
  38. G Balzano16,
  39. I Frigerio17,
  40. R Girelli17,
  41. M Delhaye18,
  42. B Bernier18,
  43. H Wang19,
  44. K T Jang20,
  45. D H Song21,
  46. M T Huggett22,
  47. K W Oppong22,
  48. L Pererva23,
  49. K V Kopchak23,
  50. M Del Chiaro24,
  51. R Segersvard24,
  52. L S Lee25,
  53. D Conwell25,
  54. A Osvaldt26,
  55. V Campos26,
  56. G Aguero Garcete27,
  57. B Napoleon27,
  58. I Matsumoto28,
  59. M Shinzeki28,
  60. F Bolado29,
  61. J M Urman Fernandez29,
  62. M G Keane30,
  63. S P Pereira30,
  64. I Araujo Acuna31,
  65. E C Vaquero31,
  66. M R Angiolini32,
  67. A Zerbi32,
  68. J Tang33,
  69. R W Leong33,
  70. A Faccinetto34,
  71. G Morana34,
  72. M C Petrone35,
  73. P G Arcidiacono35,
  74. J H Moon36,
  75. H J Choi36,
  76. R S Gill37,
  77. D Pavey37,
  78. M Ouaïssi38,
  79. B Sastre38,
  80. M Spandre39,
  81. C G De Angelis39,
  82. M A Rios-Vives40,
  83. M Concepcion-Martin40,
  84. T Ikeura41,
  85. K Okazaki41,
  86. L Frulloni42,
  87. O Messina42,
  88. P Lévy1
  1. 1Department of Gastroenterology and Pancreatology, Beaujon Hospital, AP-HP, Clichy, France
  2. 2The Pancreas Institute, G.B. Rossi Hospital, University of Verona Hospital Trust, Verona, Italy
  3. 3Division of Gastroenterology and Hepatology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
  4. 4Division of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
  5. 5Department of Pathology, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
  6. 6Departments of Surgery and Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
  7. 7Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
  8. 8First Department of Surgery, Yamagata University Faculty of Medicine, Yamagata, Japan
  9. 9Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
  10. 10Division of Gastroenterology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
  11. 11Department of Surgery, Yonsei University College of Medicine, Pancreaticobiliary Cancer Clinic, Yonsei Cancer Center, Severance Hospital, Seoul, Korea
  12. 12Pancreatic Surgery Unit, Department of Surgery, Polytechnic University of Marche Region, Ancona-Torrette, Italy
  13. 13NIHR Pancreas Biomedical Research Unit, Department of Molecular and Clinical Cancer Medicine, Royal Liverpool University Hospital, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
  14. 14Department of Surgery, Oncology and Gastroenterology, 3rd Surgical Clinic, University of Padua, Padua, Italy
  15. 15Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum-University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
  16. 16Pancreatic Surgery Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
  17. 17Hepato-Pancreato-Biliary Unit, Pederzoli Hospital, Peschiera del Garda, Italy
  18. 18Department of Gastroenterology, Hepatopancreatology and GI Oncology, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
  19. 19Institute of Hepatopancreatobiliary Surgery, Southwest Hospital, Third Military Medical University, Chongqing, China
  20. 20Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
  21. 21Department of Pathology, Gyeongsang National University School of Medicine, Jinju, Korea
  22. 22Hepato-Pancreato-Biliary Unit, Freeman Hospital, Newcastle upon Tyne, UK
  23. 23National Institute of Surgery and Transplantology named after Shalimov, Kiev, Ukraine
  24. 24Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet at Center for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden
  25. 25Division of Gastroenterology, Brigham and Women's Hospital, Boston, Massachusetts, USA
  26. 26Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
  27. 27Hôpital Privé Mermoz, Gastroentérologie, Lyon, France
  28. 28Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
  29. 29Gastroenterology Department, Hospital de Navarra, Pamplona, Spain
  30. 30Department of Gastroenterology and Hepatology, University College Hospital, London, UK
  31. 31Department of Gastroenterology, Hospital Clinic, CIBEREHD, IDIBAPS, University of Barcelona, Barcelona, Spain
  32. 32Department of Pancreatic Surgery, Humanitas Research Hospital, Rozzano, Milan, Italy
  33. 33Gastroenterology and Liver Services, Concord Hospital, Sydney, New South Wales, Australia
  34. 34Radiological Department, General Hospital Cá Foncello, Treviso, Italy
  35. 35Division of Gastroenterology and Gastrointestinal Endoscopy, San Raffaele Scientific Institute, Milan, Italy
  36. 36Department of Internal Medicine, Digestive Disease Center and Research Institute, SoonChunHyang University School of Medicine, Bucheon, Korea
  37. 37Department of Gastroenterology, Bankstown-Lidcombe Hospital, Bankstown, New South Wales, Australia
  38. 38Department of Digestive Surgery, Timone Hospital, Marseille, France
  39. 39Gastrohepatology Department, San Giovanni Battista Molinette Hospital, University of Turin, Turin, Italy
  40. 40Gastroenterology Department, Hospital de la Santa Creu i Sant Pau, Institut de Reçerca—IIB Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
  41. 41The Third Department of Internal Medicine, Division of Gastroenterology and Hepatology, Kansai Medical University, Osaka, Japan
  42. 42Department of Medicine, Pancreas Center, University of Verona, Verona, Italy
  1. Correspondence to Professor P Lévy, Department of Gastroenterology and Pancreatology, Beaujon Hospital, AP-HP, 100 Boulevard du Général Leclerc, 92118 Clichy Cedex, France; philippe.levy{at}bjn.aphp.fr

Abstract

Objectives Serous cystic neoplasm (SCN) is a cystic neoplasm of the pancreas whose natural history is poorly known. The purpose of the study was to attempt to describe the natural history of SCN, including the specific mortality.

Design Retrospective multinational study including SCN diagnosed between 1990 and 2014.

Results 2622 patients were included. Seventy-four per cent were women, and median age at diagnosis was 58 years (16–99). Patients presented with non-specific abdominal pain (27%), pancreaticobiliary symptoms (9%), diabetes mellitus (5%), other symptoms (4%) and/or were asymptomatic (61%). Fifty-two per cent of patients were operated on during the first year after diagnosis (median size: 40 mm (2–200)), 9% had resection beyond 1 year of follow-up (3 years (1–20), size at diagnosis: 25 mm (4–140)) and 39% had no surgery (3.6 years (1–23), 25.5 mm (1–200)). Surgical indications were (not exclusive) uncertain diagnosis (60%), symptoms (23%), size increase (12%), large size (6%) and adjacent organ compression (5%). In patients followed beyond 1 year (n=1271), size increased in 37% (growth rate: 4 mm/year), was stable in 57% and decreased in 6%. Three serous cystadenocarcinomas were recorded. Postoperative mortality was 0.6% (n=10), and SCN's related mortality was 0.1% (n=1).

Conclusions After a 3-year follow-up, clinical relevant symptoms occurred in a very small proportion of patients and size slowly increased in less than half. Surgical treatment should be proposed only for diagnosis remaining uncertain after complete workup, significant and related symptoms or exceptionally when exists concern with malignancy. This study supports an initial conservative management in the majority of patients with SCN.

Trial registration number IRB 00006477.

  • PANCREATIC TUMOURS
  • PANCREATIC SURGERY

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