Diagnosis and treatment of pancreatic cystic tumor in 158 cases_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

MA Yudong ¹ , XU Muchen ¹ , ZHANG Pengbo ² , WU Nai ² ,  REN Zeqiang ²

1. Xuzhou Medical University, Xuzhou, Jiangsu 221000, P. R. China;
2. Department of General Surgery, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu 221000, P. R. China;

Corresponding author：

REN Zeqiang, Email: rzq0805@163.com

Keywords：

pancreatic cystic neoplasm; diagnosis; surgery

DOI：

10.7507/1007-9424.202003146

Video：

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Objective To summarize the experience of diagnosis and treatment of pancreatic cystic neoplasms (PCN).Method The general information, imaging findings, preoperative blood biochemical indexes, tumor markers, operation related data, postoperative complications, and pathological results of patients with PCN confirmed by pathological examination in Affiliated Hospital of Xuzhou Medical University from January 1, 2014 to December 31, 2019 were retrospectively analyzed.Results Among the 158 patients who underwent surgical resection, the male to female ratio was 1∶1.6, and the median age was 56.2 years (range 26 to 82 years). Serous cystadenoma (SCN) was the most common, accounting for 34.2% (n=54), followed by mucinous cystadenoma (MCN) and intraductal papillary mucinous neoplasm (IPMN), accounting for 26.6% (n=42) and 20.2% (n=32). The proportion of solid pseudopapillary tumor (SPT) was the smallest, which was 19.0% (n=30). The PCN malignant rate was 19.0% (n=30), with the highest malignant rate being IPMN (43.8%, n=14), and the lowest being SCN (3.7%, n=2). Patients with PCN malignant group had significantly higher serum CA19-9, CEA, CA125, and neutrophil/lymphocyte ratio (NLR) than those in the benign group（all P<0.05）. The preoperative diagnosis of PCN was ambiguous, and the rate of misdiagnosis was high. The correct diagnosis rate of accurate preoperative specific classification was only 31.6% (n=50), and the lowest SCN (14.8%, n=8). High CA19-9, high NLR value, tumor location in the head/neck of pancreas and enhanced solid component were independent predictors of malignant PCN (P<0.05).Conclusion Improving the preoperative diagnosis ability of PCN and accurately determining the PCN classification before operation are helpful for the standardized treatment of PCN.

Citation： MA Yudong, XU Muchen, ZHANG Pengbo, WU Nai, REN Zeqiang. Diagnosis and treatment of pancreatic cystic tumor in 158 cases. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2021, 28(1): 89-94. doi: 10.7507/1007-9424.202003146 Copy

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2.	Ehab A, Ayman EN, Ehab EH, et al. Pancreatic cystic neoplasms: predictors of malignant behavior and management. Saudi J Gastroenterol, 2013, 19(1): 45-53.
3.	European Study Group on Cystic Tumours of the Pancreas. European evidence-based guidelines on pancreatic cystic neoplasms. Gut, 2018, 67(5): 789-804.
4.	van Huijgevoort N, Del Chiaro M, Wolfgang CL, et al. Diagnosis and management of pancreatic cystic neoplasms: current evidence and guidelines. Nat Rev Gastroenterol Hepatol, 2019, 16(11): 676-689.
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6.	Pozzi-Mucelli RM, Rinta-Kiikka I, Wünsche K, et al. Pancreatic MRI for the surveillance of cystic neoplasms: comparison of a short with a comprehensive imaging protocol. Eur Radiol, 2017, 27(1): 41-50.
7.	Du C, Chai NL, Linghu EQ, et al. Comparison of endoscopic ultrasound, computed tomography and magnetic resonance imaging in assessment of detailed structures of pancreatic cystic neoplasms. World J Gastroenterol, 2017, 23(17): 3184-3192.
8.	Wu J, Wang Y, Li Z, et al. Accuracy of Fukuoka and American Gastroenterological Association Guidelines for predicting advanced neoplasia in pancreatic cyst neoplasm: a meta-analysis. Ann Surg Oncol, 2019, 26(13): 4522-4536.
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12.	Bassi C, Dervenis C, Butturini G, et al. Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery, 2005, 138(1): 8-13.
13.	Tanaka M, Fernández-Del Castillo C, Kamisawa T, et al. Revisions of international consensus Fukuoka guidelines for the management of IPMN of the pancreas. Pancreatology, 2017, 17(5): 738-753.
14.	Kwon RS. Advances in the diagnosis of cystic neoplasms of the pancreas. Curr Opin Gastroenterol, 2012, 28(5): 494-500.
15.	Farrell JJ. Prevalence, diagnosis and management of pancreatic cystic neoplasms: current status and future directions. Gut Liver, 2015, 9(5): 571-589.
16.	Sethi V, Giri B, Saluja A, et al. Insights into the pathogenesis of pancreatic cystic neoplasms. Dig Dis Sci, 2017, 62(7): 1778-1786.
17.	Spinelli KS, Fromwiller TE, Daniel RA, et al. Cystic pancreatic neoplasms: observe or operate. Ann Surg, 2004, 239(5): 651-657.
18.	Lan C, Li X, Wang X, et al. A new combined criterion to better predict malignant lesions in patients with pancreatic cystic neoplasms. Cancer Biol Med, 2018, 15(1): 70-78.
19.	Brugge WR. Diagnosis and management of cystic lesions of the pancreas. J Gastrointest Oncol, 2015, 6(4): 375-388.
20.	Lee HJ, Kim MJ, Choi JY, et al. Relative accuracy of CT and MRI in the differentiation of benign from malignant pancreatic cystic lesions. Clin Radiol, 2011, 66(4): 315-321.
21.	Jang DK, Song BJ, Ryu JK, et al. Preoperative diagnosis of pancreatic cystic lesions: the accuracy of endoscopic ultrasound and cross-sectional imaging. Pancreas, 2015, 44(8): 1329-1233.
22.	Liu L, Xu H, Wang W, et al. A preoperative serum signature of CEA⁺/CA125⁺/CA19-9 ≥ 1 000 U/mL indicates poor outcome to pancreatectomy for pancreatic cancer. Int J Cancer, 2015, 136(9): 2216-2227.
23.	Hwang DW, Jang JY, Lim CS, et al. Determination of malignant and invasive predictors in branch duct type intraductal papillary mucinous neoplasms of the pancreas: a suggested scoring formula. J Korean Med Sci, 2011, 26(6): 740-746.
24.	Cao S, Hu Y, Gao X, et al. Serum carbohydrate antigen 19-9 in differential diagnosis of benign and malignant pancreatic cystic neoplasms: a meta-analysis. PLoS One, 2016, 11(11): e0166406.
25.	Egberts JH, Cloosters V, Noack A, et al. Anti-tumor necrosis factor therapy inhibits pancreatic tumor growth and metastasis. Cancer Res, 2008, 68(5): 1443-1450.
26.	Zhang X, Zhang W, Feng LJ. Prognostic significance of neutrophil lymphocyte ratio in patients with gastric cancer: a meta-analysis. PLoS One, 2014, 9(11): e111906.
27.	Luo G, Guo M, Liu Z, et al. Blood neutrophil-lymphocyte ratio predicts survival in patients with advanced pancreatic cancer treated with chemotherapy. Ann Surg Oncol, 2015, 22(2): 670-676.
28.	Goh KP, Tan DM, Chan CY, et al. Are preoperative blood neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios useful in predicting malignancy in surgically-treated mucin-producing pancreatic cystic neoplasms. J Surg Oncol, 2015, 112(4): 366-371.
29.	林侃如, 朱剑清, 李骥, 等. 胰腺浆液性囊腺瘤 161 例诊治体会及术前误诊原因分析. 中华外科杂志, 2018, 56(8): 591-596.

1. Dudeja V, Allen PJ. Premalignant cystic neoplasms of the pancreas. Semin Oncol, 2015, 42(1): 70-85.
2. Ehab A, Ayman EN, Ehab EH, et al. Pancreatic cystic neoplasms: predictors of malignant behavior and management. Saudi J Gastroenterol, 2013, 19(1): 45-53.
3. European Study Group on Cystic Tumours of the Pancreas. European evidence-based guidelines on pancreatic cystic neoplasms. Gut, 2018, 67(5): 789-804.
4. van Huijgevoort N, Del Chiaro M, Wolfgang CL, et al. Diagnosis and management of pancreatic cystic neoplasms: current evidence and guidelines. Nat Rev Gastroenterol Hepatol, 2019, 16(11): 676-689.
5. Plichta JK, Brosius JA, Pappas SG, et al. The changing spectrum of surgically treated cystic neoplasms of the pancreas. HPB Surg, 2015, 2015: 791704.
6. Pozzi-Mucelli RM, Rinta-Kiikka I, Wünsche K, et al. Pancreatic MRI for the surveillance of cystic neoplasms: comparison of a short with a comprehensive imaging protocol. Eur Radiol, 2017, 27(1): 41-50.
7. Du C, Chai NL, Linghu EQ, et al. Comparison of endoscopic ultrasound, computed tomography and magnetic resonance imaging in assessment of detailed structures of pancreatic cystic neoplasms. World J Gastroenterol, 2017, 23(17): 3184-3192.
8. Wu J, Wang Y, Li Z, et al. Accuracy of Fukuoka and American Gastroenterological Association Guidelines for predicting advanced neoplasia in pancreatic cyst neoplasm: a meta-analysis. Ann Surg Oncol, 2019, 26(13): 4522-4536.
9. 田孝东, 杨尹默. 保守观察还是手术切除: 胰腺囊性肿瘤外科治疗策略. 浙江医学, 2017, 39(1): 4-6, 11.
10. Edge SB, Compton CC. The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol, 2010, 17(6): 1471.
11. Wente MN, Bassi C, Dervenis C, et al. Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS). Surgery, 2007, 142(5): 761-768.
12. Bassi C, Dervenis C, Butturini G, et al. Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery, 2005, 138(1): 8-13.
13. Tanaka M, Fernández-Del Castillo C, Kamisawa T, et al. Revisions of international consensus Fukuoka guidelines for the management of IPMN of the pancreas. Pancreatology, 2017, 17(5): 738-753.
14. Kwon RS. Advances in the diagnosis of cystic neoplasms of the pancreas. Curr Opin Gastroenterol, 2012, 28(5): 494-500.
15. Farrell JJ. Prevalence, diagnosis and management of pancreatic cystic neoplasms: current status and future directions. Gut Liver, 2015, 9(5): 571-589.
16. Sethi V, Giri B, Saluja A, et al. Insights into the pathogenesis of pancreatic cystic neoplasms. Dig Dis Sci, 2017, 62(7): 1778-1786.
17. Spinelli KS, Fromwiller TE, Daniel RA, et al. Cystic pancreatic neoplasms: observe or operate. Ann Surg, 2004, 239(5): 651-657.
18. Lan C, Li X, Wang X, et al. A new combined criterion to better predict malignant lesions in patients with pancreatic cystic neoplasms. Cancer Biol Med, 2018, 15(1): 70-78.
19. Brugge WR. Diagnosis and management of cystic lesions of the pancreas. J Gastrointest Oncol, 2015, 6(4): 375-388.
20. Lee HJ, Kim MJ, Choi JY, et al. Relative accuracy of CT and MRI in the differentiation of benign from malignant pancreatic cystic lesions. Clin Radiol, 2011, 66(4): 315-321.
21. Jang DK, Song BJ, Ryu JK, et al. Preoperative diagnosis of pancreatic cystic lesions: the accuracy of endoscopic ultrasound and cross-sectional imaging. Pancreas, 2015, 44(8): 1329-1233.
22. Liu L, Xu H, Wang W, et al. A preoperative serum signature of CEA⁺/CA125⁺/CA19-9 ≥ 1 000 U/mL indicates poor outcome to pancreatectomy for pancreatic cancer. Int J Cancer, 2015, 136(9): 2216-2227.
23. Hwang DW, Jang JY, Lim CS, et al. Determination of malignant and invasive predictors in branch duct type intraductal papillary mucinous neoplasms of the pancreas: a suggested scoring formula. J Korean Med Sci, 2011, 26(6): 740-746.
24. Cao S, Hu Y, Gao X, et al. Serum carbohydrate antigen 19-9 in differential diagnosis of benign and malignant pancreatic cystic neoplasms: a meta-analysis. PLoS One, 2016, 11(11): e0166406.
25. Egberts JH, Cloosters V, Noack A, et al. Anti-tumor necrosis factor therapy inhibits pancreatic tumor growth and metastasis. Cancer Res, 2008, 68(5): 1443-1450.
26. Zhang X, Zhang W, Feng LJ. Prognostic significance of neutrophil lymphocyte ratio in patients with gastric cancer: a meta-analysis. PLoS One, 2014, 9(11): e111906.
27. Luo G, Guo M, Liu Z, et al. Blood neutrophil-lymphocyte ratio predicts survival in patients with advanced pancreatic cancer treated with chemotherapy. Ann Surg Oncol, 2015, 22(2): 670-676.
28. Goh KP, Tan DM, Chan CY, et al. Are preoperative blood neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios useful in predicting malignancy in surgically-treated mucin-producing pancreatic cystic neoplasms. J Surg Oncol, 2015, 112(4): 366-371.
29. 林侃如, 朱剑清, 李骥, 等. 胰腺浆液性囊腺瘤 161 例诊治体会及术前误诊原因分析. 中华外科杂志, 2018, 56(8): 591-596.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Diagnosis and treatment of pancreatic cystic tumor in 158 cases

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