Management of cystic neoplasms of the pancreas

Despite the growing interest in cystic neoplasms of the pancreas, their diagnosis, treatment and prognosis are still obscure and controversial.

We studied, from September 1989 to July 1999, 21 patients (18 women) with an average age of 54.3 years who were submitted to surgical treatment for cystic neoplasms of the pancreas. Ultrasonography and computed tomography were performed in all patients.

The treatment performed was surgical resection: cephalic gastroduodenopancreatectomy, 4 patients; body and tail pancreatectomy, 11 patients; only tail pancreatectomy, 2 patients; and two other patients were submitted to enucleation of one small lesion in the head of the pancreas. Internal drainage, through cystogastrostomy or cystojejunostomy, was performed in 3 cases. Site of tumor: body and tail region, 14 cases; head of the pancreas, 7 cases. Three patients had postoperative complications (respiratory tract infection, surgical wound infection, abdominal abscess). Three patients developed diabetes mellitus during the late postoperative period. One patient died 45 days after surgical procedure.

Patients who present pancreatic cystic lesions should be submitted to surgery when local and medical conditions allow it and when intraoperative frozen biopsy excludes a pancreatic pseudocyst. If the nature of the lesion cannot be determined, it is better to err resecting a pseudocyst than by leaving or draining a cystic neoplasm, since these lesions are potentially curable.