PMID- 33378303
OWN - NLM
STAT- MEDLINE
DCOM- 20221110
LR  - 20221210
IS  - 1528-1140 (Electronic)
IS  - 0003-4932 (Linking)
VI  - 276
IP  - 6
DP  - 2022 Dec 1
TI  - Serous Cystic Neoplasms of the Pancreas Management in the Real-world: Still 
      Operating on a Benign Entity.
PG  - e868-e875
LID - 10.1097/SLA.0000000000004716 [doi]
AB  - OBJECTIVE: Our aim is to provide a real-life picture of serous cystic neoplasms 
      (SCNs) management once a presumptive diagnosis is made. SUMMARY OF BACKGROUND 
      DATA: SCNs of the pancreas are invariably benign entities. While consensus about 
      their management is lacking, surgical resection still plays a role. METHODS: 
      Presumed SCNs evaluated from 1990 to 2018 were included. Indications for surgery, 
      predictors of resection, rate, and predictors of misdiagnosis in the surgical 
      cohort and time trends of management strategies were the main outcomes. RESULTS: 
      A total of 672 presumed SCNs were included. Presence of symptoms (37%) and large 
      size (34.1%) were the most frequent indications for surgery. Symptoms (60.4% vs 
      19.0%, P < 0.001), size (45 vs 30 mm, P < 0.001), solid components (19.7% vs 
      6.2%, P < 0.001), thick walls (14.4 vs 5.6%, P = 0.001) and main pancreatic duct 
      dilation (13.4% vs 5.6%, P = 0.004) were associated with upfront resection (n = 
      134, 19.9%). Upfront resection decreased over time and 15.4% of patients 
      eventually crossed over to surgery. Increase in size (6.9 vs 1.3 mm/yr), 
      development of symptoms (25.3% vs 3.4%, P < 0.001), solid component (6.0% vs 
      1.4%, P = 0.010) or jaundice (3.6% vs 0.7%, P = 0.028) were associated with 
      crossing over to surgery. Major morbidity and mortality occurred in 17.1% and 
      1.7% of patients, respectively. Misdiagnosis occurred mostly in case of 
      macrocystic/unilocular lesions of the body-tail. CONCLUSIONS: In the real-life 
      scenario, SCNs still represent an indication for surgery particularly once large 
      and symptomatic. During surveillance, resection occurs mostly in younger 
      individuals for body/tail lesions. Evidence-based consensus on appropriate 
      indications for surgery is urgently needed.
CI  - Copyright (c) 2020 Wolters Kluwer Health, Inc. All rights reserved.
FAU - Marchegiani, Giovanni
AU  - Marchegiani G
AD  - Department of Surgery, Verona University Hospital Trust, Verona, Italy.
FAU - Caravati, Andrea
AU  - Caravati A
FAU - Andrianello, Stefano
AU  - Andrianello S
FAU - Pollini, Tommaso
AU  - Pollini T
FAU - Bernardi, Giulia
AU  - Bernardi G
FAU - Biancotto, Marco
AU  - Biancotto M
FAU - Malleo, Giuseppe
AU  - Malleo G
FAU - Bassi, Claudio
AU  - Bassi C
FAU - Salvia, Roberto
AU  - Salvia R
LA  - eng
PT  - Journal Article
DEP - 20201223
PL  - United States
TA  - Ann Surg
JT  - Annals of surgery
JID - 0372354
SB  - IM
MH  - Humans
MH  - *Pancreatic Neoplasms/diagnosis/surgery/pathology
MH  - Pancreas/pathology
COIS- The authors report no conflicts of interest.
EDAT- 2020/12/31 06:00
MHDA- 2022/11/11 06:00
CRDT- 2020/12/30 17:11
PHST- 2020/12/31 06:00 [pubmed]
PHST- 2022/11/11 06:00 [medline]
PHST- 2020/12/30 17:11 [entrez]
AID - 00000658-202212000-00051 [pii]
AID - 10.1097/SLA.0000000000004716 [doi]
PST - ppublish
SO  - Ann Surg. 2022 Dec 1;276(6):e868-e875. doi: 10.1097/SLA.0000000000004716. Epub 
      2020 Dec 23.