Cystic tumors of the pancreas: high malignant potential

Cystic tumors of the pancreas are rare, accounting for 10% of pancreatic cysts and 1% of all pancreatic tumors; surgery is dictated by their malignant potential.

To evaluate the malignancy rate of pancreatic cystic tumors and patient outcome, and to determine predictors for malignant potential.

We retrospectively reviewed the medical records of patients who underwent pancreatic resection for cystic tumors between January 1996 and December 2007.

The charts showed that 116 patients were operated on for a pancreatic cystic tumor; most were women (63%). The chief complaint was abdominal pain (57%). Incidental detection occurred in 27%. Preoperative workup included ultrasound, tomography, endoscopic ultrasound and fine-needle aspiration biopsy. Indications for surgery were mucinous tumor, symptomatic or enlarging cyst under surveillance, high carcinoembryonic antigen levels within the cyst, and typical manifestations of intraductal papillary mucinous tumor (IPMT). All tumors but one were resectable. Whipple operation was performed in 40%, distal pancreatectomy in 55% and total pancreatectomy in 5%. Mucinous tumors were found in 40%, of which 37T were cystadenocarcinoma and/or borderline tumor. IPMT was found in 39%; 38% of them with cancer. Other pathologies included symptomatic serous cystadenomas, neuroendocrine cystic tumors and pseudopapillary tumors. The perioperative mortality rate was 2.6%. Five-year survival rates for patients with benign vs. invasive/borderline mucinous neoplasms was 90% vs. 59%, and for non-invasive vs. invasive IPMT 89% vs. 45% respectively.

Cystic tumors of the pancreas should be carefully evaluated. Surgery should be considered when a mucinous component is suspected due to the high rate of malignancy. Complete resection carries a high cure rate even in the presence of cancer.