Surveillance and management for serous cystic neoplasms of the pancreas based on total hazards—a multi-center retrospective study from China

作者：Chinese Young Surgeon Study Group in Pancreatic Surgery, Wenchuan Wu, Ji Li, Ning Pu, Gang Li, Xin Wang, Gang Zhao, Lei Wang, Xiaodong Tian, Chunhui Yuan, Yi Miao, Kuirong Jiang, Jun Cao, Xiaowu Xu, Xueli Bai, Yongsheng Yang, Fubao Liu, Xuewei Bai, Rui Kong, Zheng Wang, Deliang Fu, Wenhui Lou · 发表于：Annals of Translational Medicine · 年份：2019 · DOI：10.21037/atm.2019.12.70 · 被引用次数：10 · 研究领域：Pancreatic and Hepatic Oncology Research、Cholangiocarcinoma and Gallbladder Cancer Studies、Pancreatitis Pathology and Treatment

BACKGROUND: Serous cystic neoplasms (SCN) rarely have malignant potential, so accurate diagnosis of SCN is crucial for proper clinical management, especially to avoid unnecessary surgeries. However, the misdiagnosis of other pancreatic cystic neoplasm instead of SCN may highly increase the risk of malignancy in patients who receive no surgery. METHODS: , 2016 were retrieved to evaluate the malignancy risk of SCN. RESULTS: Among the 678 patients confirmed to have SCN with postoperative pathologic analysis, 649 patients (95.7%) had only one lesion and the average maximum diameter was 3.8±2.47 cm. Four patients were pathologically verified as having serous cystadenocarcinoma, so the SCN actual malignancy rate was 0.6%, while the mortality due to pancreatic surgery in these high-volume centers was nearly 0.2-2%. However, among the 99 SCN patients based on preoperative radiology, three were confirmed to have intraductal papillary mucinous neoplasms (IPMN), nine as mucinous cystic neoplasms (MCN), and four as solid pseudopapillary tumors (SPT) after postoperative pathological analysis. Thus, the total theoretical malignancy rate resulting from preoperative misdiagnosis was elevated to approximately 2.9%, higher than the risk of perioperative mortality. CONCLUSIONS: When SCN can't be accurately distinguished from cystic tumors of pancreas, the malignant risk of cystic tumors may be higher than perioperative risk. However, if it can be diagnosed as SCN accurately, surgery can be avoi...