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. 2016 Feb;65(2):305-12.
doi: 10.1136/gutjnl-2015-309638. Epub 2015 Jun 4.

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)

B Jais  1 , V Rebours  1 , G Malleo  2 , R Salvia  2 , M Fontana  2 , L Maggino  2 , C Bassi  2 , R Manfredi  2 , R Moran  3 , A M Lennon  3 , A Zaheer  3 , C Wolfgang  3 , R Hruban  3 , G Marchegiani  4 , C Fernández Del Castillo  4 , W Brugge  4 , Y Ha  5 , M H Kim  5 , D Oh  5 , I Hirai  6 , W Kimura  6 , J Y Jang  7 , S W Kim  7 , W Jung  7 , H Kang  8 , S Y Song  8 , C M Kang  9 , W J Lee  9 , S Crippa  10 , M Falconi  10 , I Gomatos  11 , J Neoptolemos  11 , A C Milanetto  12 , C Sperti  12 , C Ricci  13 , R Casadei  13 , M Bissolati  14 , G Balzano  14 , I Frigerio  15 , R Girelli  15 , M Delhaye  16 , B Bernier  16 , H Wang  17 , K T Jang  18 , D H Song  19 , M T Huggett  20 , K W Oppong  20 , L Pererva  21 , K V Kopchak  21 , M Del Chiaro  22 , R Segersvard  22 , L S Lee  23 , D Conwell  23 , A Osvaldt  24 , V Campos  24 , G Aguero Garcete  25 , B Napoleon  25 , I Matsumoto  26 , M Shinzeki  26 , F Bolado  27 , J M Urman Fernandez  27 , M G Keane  28 , S P Pereira  28 , I Araujo Acuna  29 , E C Vaquero  29 , M R Angiolini  30 , A Zerbi  30 , J Tang  31 , R W Leong  31 , A Faccinetto  32 , G Morana  32 , M C Petrone  33 , P G Arcidiacono  33 , J H Moon  34 , H J Choi  34 , R S Gill  35 , D Pavey  35 , M Ouaïssi  36 , B Sastre  36 , M Spandre  37 , C G De Angelis  37 , M A Rios-Vives  38 , M Concepcion-Martin  38 , T Ikeura  39 , K Okazaki  39 , L Frulloni  40 , O Messina  40 , P Lévy  1
Affiliations

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)

B Jais et al. Gut. 2016 Feb.

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.

Keywords: PANCREATIC SURGERY; PANCREATIC TUMOURS.

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