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Views Total views. Actions Shares. Embeds 0 No embeds. No notes for slide. Pancreatic Cystic Neoplasm. Pancreatic cystic neoplasm. Pancreatic cystic neoplasms. Serous Cystic Tumors: 9. Serous Cystic Tumors: Mucinous Cystic Neoplasm Mucinous Cystic Neoplasm: Observation if no candidate with small tumors. Mucinous Cystic Neoplasm: Treatment Intraductal Papillary Mucinous Neoplasm.

J Am Coll Surg. You just clipped your first slide! Clipping is a handy way to collect important slides you want to go back to later. Now customize the name of a clipboard to store your clips. Visibility Others can see my Clipboard. Therefore, the negative predictive value to exclude a mucinous lesion is very high, and thus, in my view, this helps in decision making. All other patients need lifelong follow-up irrespective of the type of management.

Treatment of Pancreatic Cystic Tumors

Also, in patients in whom an operation would not be considered under any circumstance because of patient preference or comorbidities. Mayerle: I entirely agree with the criteria mentioned above and would only add that if comorbidity or age preclude surgical therapy, then follow-up is symptom-based. The further follow-up rhythm depends on the size. EUS if modification of symptoms or images.


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Mayerle: To sufficiently answer this question, I would like to turn the readers' attention to the recently published European guidelines on PCN which suggest evidence-based follow-up algorithms Gut ; In addition, the revised Fukuoka consensus guidelines published in give valid recommendations for follow-up. However, measurements of CA and CEA are non-invasive as well as inexpensive, and may be indicative of malignant transformation, so they belong to our routine surveillance workup of unresected IPMN.

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Mistakes in pancreatic cystic neoplasms and how to avoid them

CA should be discarded. Mayerle: In my view, symptoms are in many instances not appreciated sufficiently, and it is always a combination of symptoms, imaging, and laboratory workup leading to a clinical decision for follow-up. However, cysts located in the head of the pancreas tend to be symptomatic more often pancreatitis, cholestasis, jaundice, As far as possible, limited resection should be discussed enucleation, ablation of uncus, central pancreatectomy.


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  • Multifocal IPMNs may be in need of a total pancreatectomy. Others may be done as an enucleation, laparoscopic or robotic. IPMNs with high-risk stigmata and worrisome features originating from the pancreatic duct system have a favorable prognosis only after oncologic resections, so these PCLs are no candidates for parenchyma-sparing procedures PSP such as enucleation. PSP may be offered to highly selected patients who are young and fit enough to survive this complicated surgery in order to decrease their long-term risk of diabetes and exocrine insufficiency and thus increase their quality of life.

    In this respect, some ideal patients with Frantz's tumor in the central part of the pancreas are suitable for oncologic segmental resection.


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    • Once again, if the decision to remove it is because the risk of malignancy is higher, then a proper oncologic resection should be performed. By definition, an enucleation of a branch-duct IPMN is leaving behind part of the branch duct that is connecting to the main ductal system. I do middle or central pancreatectomies for branch-duct IPMNs, and carefully check the margins intraoperatively.

      Certainly not in main-duct IPMN as in this case one has to consider an oncological procedure in any event. On the one hand, discovery of reliable early biomarkers of malignant transformation may be crucial for determining the treatment strategy.

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      Development of liquid biopsy for detection of malignant PCLs may help to precise indications for surgery in the future. On the other hand, PCLs are associated with soft pancreatic tissue, and thus their resection comes along with very high rates of postoperative pancreatic fistula POPF. A blood-based test that could triage patients with no risk would be a major advance, since they could get this periodically, reserving the imaging for patients who do have a risk.

      This blood test could be based on circulating tumor cells or exosomes. Mayerle: We need to work on increasing the diagnostic accuracy of cystic pancreatic lesions to improve the patients' care. We need to publicly report that the risk of malignancy in PCLs is lower than previously reported and to give the all-clear to fearful patients whenever possible. Copyright: All rights reserved.

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      The Best of Pancreatic Cyst Conference: Case 4

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