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Diagnosis and treatment in cystic neoplasms of the pancreas: Analysis of 12 cases and review of the literature

Year 2012, Volume: 39 Issue: 4, 547 - 551, 01.12.2012
https://doi.org/10.5798/diclemedj.0921.2012.04.0198

Abstract

Objectives: Cystic Neoplasms of the Pancreas (CNP) accounts for only 1-5% of all pancreatic neoplasms but in recent years approximately 30% of all pancreatic resections are performed for CNP. In this study we aimed to argue diagnosis, treatment and outcomes of the patients whom operated in our clinic for CNP. Materials and methods: The demographic characteristics, preoperative findings, surgical procedures, histopathological diagnosis, postoperative complications and long term follow-up outcomes of the CNP patients operated in our clinic between 2009 -Jan and 2012-Feb were evaluated. Results: One patient was male,11 patients were female and mean age was 51,5 years (19-73 years).Localizations of the lesions were in the head of pancreas for 4 patients, in the body for 2 patients and in tail for 6 patients. Mean size of the cysts was 5.1 cm (3-10 cm).Pylorus-reserved pancreaticoduodenectomy for 4 patients, subtotal/distal pancreatectomy + splenectomy for 7 patients and spleen reserved distal pancreatectomy was performed for 1 patient. Histopathological diagnosis was reported as serous cystadenoma in 6, mucinous cystadenoma in 3, mucinous cystadenocarcinoma in 2 and pseudocyst in 1 patient respectively. Postoperative complication rate was 33%. Mean follow-up time was 18.4 months (2-38 months). Conclusions: Management should be based upon on carefully weighting the malignant potential of a pancreatic cystic lesions and the risk of surgery.

References

  • Visser BC, Muthusamy VR, Yeh BM, et al. Diagnostic evaluation of cystic pancreatic lesions. HPB (Oxford) 2008;10(1): 63-9.
  • Fernandez-del Castillo C, Warshaw AL. Cystic tumors of the pancreas. Surg Clin North Am 1995;75(5):1001-16.
  • Federle MP, McGrath KM. Cystic neoplasms of the pancreas. Gastroenterol Clin North Am. 2007;36(2):365-76.
  • Brugge WR, Lauwers GY, Sahani D, et al. Cystic neoplasms of the pancreas. N Engl J Med. 2004;351(12):1218-26.
  • Shyr YM, Su CH, Tsay SH, et al. Mucin-producing neo- plasms of the pancreas. Intraductal papillary and mucinous cystic neoplasms. Ann Surg 1996; 223(2): 141-6
  • Oh HC, Kim MH, Hwang CY, et al. Cystic lesions of the pancreas: challenging issues in clinical practice. Am J Gas- troenterol 2008; 103(1):229-39.
  • Yamao K, Nakamura T, Suzuki T, et al. Endoscopic diagnosis and staging of mucinous cystic neoplasms and intraductal papillary-mucinous tumors. J Hepatobiliary Pancreat Surg 2003;10(2):142-6.
  • Sedlack R, Affi A, Vazquez-Sequeiros E, et al. Utility of EUS in the evaluation of cystic pancreatic lesions. Gastrointest Endosc 2002;56(4):543-7.
  • Hernandez LV, Mishra G, Forsmark C, et al. Role of endo- scopic ultrasound (EUS) and EUS-guided fine needle aspi- ration in the diagnosis and treatment of cystic lesions of the pancreas. Pancreas 2002; 25(3): 222-8.
  • Brugge WR, Lewandrowski K, Lee-Lewandrowski E, et al. Diagnosis of pancreatic cystic neoplasms: a report of the cooperative pancreatic cyst study. Gastroenterology 2004;126(5):1330-6.
  • Adsay VN. Cystic lesions of the pancreas. Mod Pathol 2007; 20(Suppl 1):S71-93.
  • Basturk O, Coban I, Adsay VN. Pancreatic cysts: pathologic classification, differential diagnosis, and clinical implica- tions. Arch Pathol Lab Med 2009; 133(3):423-38.
  • Sakorafas GH, Sarr MG. Cystic neoplasms of the pan- creas; what a clinician should know. Cancer Treat Rev 2005;31(7):507-35.
  • Compagno J, Oertel JE. Mucinous cystic neoplasms of the pancreas with overt and latent malignancy (cystadenocar- cinoma and cystadenoma). A clinicopathologic study of 41 cases. Am J Clin Pathol 1978;69(6):573-80.
  • Kosmahl M, Pauser U, Anlauf M, et al. Cystic pancreas tumors and their classification: features old and new. Patho- loge 2005;26(1):22-30.
  • Akan B, K.Sahora,H.Puhalla et al.Cystic Neoplasms of the Pancreas:Conservative or Operative Treatment? Eur. Surg.2008;40(5):220-6.
  • Coelho JCU,Valle CL,Ribas BM, et al. Surgical treatment of cystic neoplasms of the pancreas. Arq Gastroentero- log.2010;47(2):135-40.
  • Society for Surgery of the Alimentary Tract. SSAT patient care guidelines. Cystic neoplasms of the pancreas. J Gastro- intest Surg. 2007;11(9):1225-7.
  • Melotti G, Butturini G, Piccoli M, et al. Laparoscopic distal pancreatectomy: results on a consecutive series of 58 pa- tients. Ann Surg 2007; 246(1): 77-82
  • Takaori K, Tanigawa N. Laparoscopic pancreatic resection: The past, present, and future. Surg Today 2007; 37(7): 535- 45.
  • Lee SY, Goh BK, Tan YM, et al. Spleen-preserving distal pancreatectomy. Singapore Med J 2008; 49(11):883-5.
  • Maker AV, Lee LS, Raut CP et al. Cytology from pancreatic cysts has marginal utility in surgical decision-making. Ann Surg Oncol 2008; 15(11):3187-92.
  • Ramazan D, Kadim B, Serif Y, Abdullah A. Dicle Üniver- sitesi Hastanesi Gastroenteroloji Kliniğinin son on yıllık pankreas kanserli olguları. Dicle Tıp Dergisi;31(1):58-61.

Pankreasın kistik neoplazilerinde tanı ve tedavi: 12 olgunun analizi ve literatür taraması

Year 2012, Volume: 39 Issue: 4, 547 - 551, 01.12.2012
https://doi.org/10.5798/diclemedj.0921.2012.04.0198

Abstract

Amaç: Pankreasın kistik neoplazileri (PKN) tüm pankreas neoplazilerinin %1-5'ini oluşturur ancak son yıllarda pankreatik rezeksiyonların yaklaşık %30 kadarı PKN'ler nedeniyle yapılmaktadır. Bu çalışmada, kliniğimizde PKN ön tanısıyla ameliyat edilen hastaların klinik verileri eşliğinde PKN'de tanı, tedavi ve takip uygulamaları ile bunların sonuçları tartışılmıştır. Gereç ve yöntem: Ocak-2009 ile Şubat-2012 yılları arasında kliniğimizde PKN ön tanısı alan 12 hastanın demografik özellikleri, ameliyat öncesi bulguları, uygulanan cerrahi yöntemler, patoloji sonuçları, ameliyat sonrası komplikasyonlar ve uzun süreli takip sonuçları değerlendirildi. Bulgular: Hastaların 1\'i erkek,11'i kadın ve ortalama yaşları 51,5 (19-73 arası) idi. Lezyonlar 4 hastada pankreas başında, 2 hastada gövdede ve 6 hastada kuyrukta yerleşmişti. Ortalama kist boyutu 5,1 cm (3-10 cm arası) idi. Dört hastaya pilor koruyucu pankreatikoduodenektomi,7 hastaya subtotal pankreatektomi/distal pankreatektomi+splenektomi, 1 hastaya ise dalak koruyucu distal pankreatektomi yapıldı. Altı hastada doku tanısı seröz kistadenoma (SKA), 3 hastada müsinöz kistadenoma (MKA), 2 hastada müsinöz kistadenokarsinoma (MKAK), 1 hastada ise psödokist olarak rapor edildi. Postoperatif dönemdeki komplikasyon oranımız %33 idi. Hastaların ortalama takip süresi 18,4 ay (2-38 ay arası) olarak hesaplandı. Sonuç: PKN ön tanısı alan hastalarda malignite potansiyeli ve cerrahi riskler hasta bazında değerlendirilerek karar verilmelidir.

References

  • Visser BC, Muthusamy VR, Yeh BM, et al. Diagnostic evaluation of cystic pancreatic lesions. HPB (Oxford) 2008;10(1): 63-9.
  • Fernandez-del Castillo C, Warshaw AL. Cystic tumors of the pancreas. Surg Clin North Am 1995;75(5):1001-16.
  • Federle MP, McGrath KM. Cystic neoplasms of the pancreas. Gastroenterol Clin North Am. 2007;36(2):365-76.
  • Brugge WR, Lauwers GY, Sahani D, et al. Cystic neoplasms of the pancreas. N Engl J Med. 2004;351(12):1218-26.
  • Shyr YM, Su CH, Tsay SH, et al. Mucin-producing neo- plasms of the pancreas. Intraductal papillary and mucinous cystic neoplasms. Ann Surg 1996; 223(2): 141-6
  • Oh HC, Kim MH, Hwang CY, et al. Cystic lesions of the pancreas: challenging issues in clinical practice. Am J Gas- troenterol 2008; 103(1):229-39.
  • Yamao K, Nakamura T, Suzuki T, et al. Endoscopic diagnosis and staging of mucinous cystic neoplasms and intraductal papillary-mucinous tumors. J Hepatobiliary Pancreat Surg 2003;10(2):142-6.
  • Sedlack R, Affi A, Vazquez-Sequeiros E, et al. Utility of EUS in the evaluation of cystic pancreatic lesions. Gastrointest Endosc 2002;56(4):543-7.
  • Hernandez LV, Mishra G, Forsmark C, et al. Role of endo- scopic ultrasound (EUS) and EUS-guided fine needle aspi- ration in the diagnosis and treatment of cystic lesions of the pancreas. Pancreas 2002; 25(3): 222-8.
  • Brugge WR, Lewandrowski K, Lee-Lewandrowski E, et al. Diagnosis of pancreatic cystic neoplasms: a report of the cooperative pancreatic cyst study. Gastroenterology 2004;126(5):1330-6.
  • Adsay VN. Cystic lesions of the pancreas. Mod Pathol 2007; 20(Suppl 1):S71-93.
  • Basturk O, Coban I, Adsay VN. Pancreatic cysts: pathologic classification, differential diagnosis, and clinical implica- tions. Arch Pathol Lab Med 2009; 133(3):423-38.
  • Sakorafas GH, Sarr MG. Cystic neoplasms of the pan- creas; what a clinician should know. Cancer Treat Rev 2005;31(7):507-35.
  • Compagno J, Oertel JE. Mucinous cystic neoplasms of the pancreas with overt and latent malignancy (cystadenocar- cinoma and cystadenoma). A clinicopathologic study of 41 cases. Am J Clin Pathol 1978;69(6):573-80.
  • Kosmahl M, Pauser U, Anlauf M, et al. Cystic pancreas tumors and their classification: features old and new. Patho- loge 2005;26(1):22-30.
  • Akan B, K.Sahora,H.Puhalla et al.Cystic Neoplasms of the Pancreas:Conservative or Operative Treatment? Eur. Surg.2008;40(5):220-6.
  • Coelho JCU,Valle CL,Ribas BM, et al. Surgical treatment of cystic neoplasms of the pancreas. Arq Gastroentero- log.2010;47(2):135-40.
  • Society for Surgery of the Alimentary Tract. SSAT patient care guidelines. Cystic neoplasms of the pancreas. J Gastro- intest Surg. 2007;11(9):1225-7.
  • Melotti G, Butturini G, Piccoli M, et al. Laparoscopic distal pancreatectomy: results on a consecutive series of 58 pa- tients. Ann Surg 2007; 246(1): 77-82
  • Takaori K, Tanigawa N. Laparoscopic pancreatic resection: The past, present, and future. Surg Today 2007; 37(7): 535- 45.
  • Lee SY, Goh BK, Tan YM, et al. Spleen-preserving distal pancreatectomy. Singapore Med J 2008; 49(11):883-5.
  • Maker AV, Lee LS, Raut CP et al. Cytology from pancreatic cysts has marginal utility in surgical decision-making. Ann Surg Oncol 2008; 15(11):3187-92.
  • Ramazan D, Kadim B, Serif Y, Abdullah A. Dicle Üniver- sitesi Hastanesi Gastroenteroloji Kliniğinin son on yıllık pankreas kanserli olguları. Dicle Tıp Dergisi;31(1):58-61.
There are 23 citations in total.

Details

Primary Language Turkish
Journal Section Research Articles
Authors

Faruk Karateke This is me

Ebru Menekşe This is me

Koray Daş This is me

Sefa Özyazıcı This is me

Selim Sözen This is me

Hilmi Bozkurt This is me

Safa Önel This is me

Publication Date December 1, 2012
Submission Date March 2, 2015
Published in Issue Year 2012 Volume: 39 Issue: 4

Cite

APA Karateke, F., Menekşe, E., Daş, K., Özyazıcı, S., et al. (2012). Pankreasın kistik neoplazilerinde tanı ve tedavi: 12 olgunun analizi ve literatür taraması. Dicle Tıp Dergisi, 39(4), 547-551. https://doi.org/10.5798/diclemedj.0921.2012.04.0198
AMA Karateke F, Menekşe E, Daş K, Özyazıcı S, Sözen S, Bozkurt H, Önel S. Pankreasın kistik neoplazilerinde tanı ve tedavi: 12 olgunun analizi ve literatür taraması. diclemedj. December 2012;39(4):547-551. doi:10.5798/diclemedj.0921.2012.04.0198
Chicago Karateke, Faruk, Ebru Menekşe, Koray Daş, Sefa Özyazıcı, Selim Sözen, Hilmi Bozkurt, and Safa Önel. “Pankreasın Kistik Neoplazilerinde Tanı Ve Tedavi: 12 Olgunun Analizi Ve literatür Taraması”. Dicle Tıp Dergisi 39, no. 4 (December 2012): 547-51. https://doi.org/10.5798/diclemedj.0921.2012.04.0198.
EndNote Karateke F, Menekşe E, Daş K, Özyazıcı S, Sözen S, Bozkurt H, Önel S (December 1, 2012) Pankreasın kistik neoplazilerinde tanı ve tedavi: 12 olgunun analizi ve literatür taraması. Dicle Tıp Dergisi 39 4 547–551.
IEEE F. Karateke, “Pankreasın kistik neoplazilerinde tanı ve tedavi: 12 olgunun analizi ve literatür taraması”, diclemedj, vol. 39, no. 4, pp. 547–551, 2012, doi: 10.5798/diclemedj.0921.2012.04.0198.
ISNAD Karateke, Faruk et al. “Pankreasın Kistik Neoplazilerinde Tanı Ve Tedavi: 12 Olgunun Analizi Ve literatür Taraması”. Dicle Tıp Dergisi 39/4 (December 2012), 547-551. https://doi.org/10.5798/diclemedj.0921.2012.04.0198.
JAMA Karateke F, Menekşe E, Daş K, Özyazıcı S, Sözen S, Bozkurt H, Önel S. Pankreasın kistik neoplazilerinde tanı ve tedavi: 12 olgunun analizi ve literatür taraması. diclemedj. 2012;39:547–551.
MLA Karateke, Faruk et al. “Pankreasın Kistik Neoplazilerinde Tanı Ve Tedavi: 12 Olgunun Analizi Ve literatür Taraması”. Dicle Tıp Dergisi, vol. 39, no. 4, 2012, pp. 547-51, doi:10.5798/diclemedj.0921.2012.04.0198.
Vancouver Karateke F, Menekşe E, Daş K, Özyazıcı S, Sözen S, Bozkurt H, Önel S. Pankreasın kistik neoplazilerinde tanı ve tedavi: 12 olgunun analizi ve literatür taraması. diclemedj. 2012;39(4):547-51.