B Jais1, V Rebours1, G Malleo2, R Salvia2, M Fontana2, L Maggino2, C Bassi2, R Manfredi2, R Moran3, A M Lennon3, A Zaheer3, C Wolfgang3, R Hruban3, G Marchegiani4, C Fernández Del Castillo4, W Brugge4, Y Ha5, M H Kim5, D Oh5, I Hirai6, W Kimura6, J Y Jang7, S W Kim7, W Jung7, H Kang8, S Y Song8, C M Kang9, W J Lee9, S Crippa10, M Falconi10, I Gomatos11, J Neoptolemos11, A C Milanetto12, C Sperti12, C Ricci13, R Casadei13, M Bissolati14, G Balzano14, I Frigerio15, R Girelli15, M Delhaye16, B Bernier16, H Wang17, K T Jang18, D H Song19, M T Huggett20, K W Oppong20, L Pererva21, K V Kopchak21, M Del Chiaro22, R Segersvard22, L S Lee23, D Conwell23, A Osvaldt24, V Campos24, G Aguero Garcete25, B Napoleon25, I Matsumoto26, M Shinzeki26, F Bolado27, J M Urman Fernandez27, M G Keane28, S P Pereira28, I Araujo Acuna29, E C Vaquero29, M R Angiolini30, A Zerbi30, J Tang31, R W Leong31, A Faccinetto32, G Morana32, M C Petrone33, P G Arcidiacono33, J H Moon34, H J Choi34, R S Gill35, D Pavey35, M Ouaïssi36, B Sastre36, M Spandre37, C G De Angelis37, M A Rios-Vives38, M Concepcion-Martin38, T Ikeura39, K Okazaki39, L Frulloni40, O Messina40, P Lévy1. 1. Department of Gastroenterology and Pancreatology, Beaujon Hospital, AP-HP, Clichy, France. 2. The Pancreas Institute, G.B. Rossi Hospital, University of Verona Hospital Trust, Verona, Italy. 3. Division of Gastroenterology and Hepatology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA Division of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA Department of Pathology, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. 4. Departments of Surgery and Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA. 5. Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. 6. First Department of Surgery, Yamagata University Faculty of Medicine, Yamagata, Japan. 7. Department of Surgery, Seoul National University College of Medicine, Seoul, Korea. 8. Division of Gastroenterology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea. 9. Department of Surgery, Yonsei University College of Medicine, Pancreaticobiliary Cancer Clinic, Yonsei Cancer Center, Severance Hospital, Seoul, Korea. 10. Pancreatic Surgery Unit, Department of Surgery, Polytechnic University of Marche Region, Ancona-Torrette, Italy. 11. NIHR Pancreas Biomedical Research Unit, Department of Molecular and Clinical Cancer Medicine, Royal Liverpool University Hospital, Institute of Translational Medicine, University of Liverpool, Liverpool, UK. 12. Department of Surgery, Oncology and Gastroenterology, 3rd Surgical Clinic, University of Padua, Padua, Italy. 13. Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum-University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy. 14. Pancreatic Surgery Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy. 15. Hepato-Pancreato-Biliary Unit, Pederzoli Hospital, Peschiera del Garda, Italy. 16. Department of Gastroenterology, Hepatopancreatology and GI Oncology, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium. 17. Institute of Hepatopancreatobiliary Surgery, Southwest Hospital, Third Military Medical University, Chongqing, China. 18. Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. 19. Department of Pathology, Gyeongsang National University School of Medicine, Jinju, Korea. 20. Hepato-Pancreato-Biliary Unit, Freeman Hospital, Newcastle upon Tyne, UK. 21. National Institute of Surgery and Transplantology named after Shalimov, Kiev, Ukraine. 22. Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet at Center for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden. 23. Division of Gastroenterology, Brigham and Women's Hospital, Boston, Massachusetts, USA. 24. Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil. 25. Hôpital Privé Mermoz, Gastroentérologie, Lyon, France. 26. Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan. 27. Gastroenterology Department, Hospital de Navarra, Pamplona, Spain. 28. Department of Gastroenterology and Hepatology, University College Hospital, London, UK. 29. Department of Gastroenterology, Hospital Clinic, CIBEREHD, IDIBAPS, University of Barcelona, Barcelona, Spain. 30. Department of Pancreatic Surgery, Humanitas Research Hospital, Rozzano, Milan, Italy. 31. Gastroenterology and Liver Services, Concord Hospital, Sydney, New South Wales, Australia. 32. Radiological Department, General Hospital Cá Foncello, Treviso, Italy. 33. Division of Gastroenterology and Gastrointestinal Endoscopy, San Raffaele Scientific Institute, Milan, Italy. 34. Department of Internal Medicine, Digestive Disease Center and Research Institute, SoonChunHyang University School of Medicine, Bucheon, Korea. 35. Department of Gastroenterology, Bankstown-Lidcombe Hospital, Bankstown, New South Wales, Australia. 36. Department of Digestive Surgery, Timone Hospital, Marseille, France. 37. Gastrohepatology Department, San Giovanni Battista Molinette Hospital, University of Turin, Turin, Italy. 38. Gastroenterology Department, Hospital de la Santa Creu i Sant Pau, Institut de Reçerca-IIB Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain. 39. The Third Department of Internal Medicine, Division of Gastroenterology and Hepatology, Kansai Medical University, Osaka, Japan. 40. Department of Medicine, Pancreas Center, University of Verona, Verona, Italy.
Abstract
OBJECTIVES: Serous cystic neoplasm (SCN) is a cystic neoplasm of the pancreas whose natural history is poorly known. The purpose of the study was to attempt to describe the natural history of SCN, including the specific mortality. DESIGN: Retrospective multinational study including SCN diagnosed between 1990 and 2014. RESULTS: 2622 patients were included. Seventy-four per cent were women, and median age at diagnosis was 58 years (16-99). Patients presented with non-specific abdominal pain (27%), pancreaticobiliary symptoms (9%), diabetes mellitus (5%), other symptoms (4%) and/or were asymptomatic (61%). Fifty-two per cent of patients were operated on during the first year after diagnosis (median size: 40 mm (2-200)), 9% had resection beyond 1 year of follow-up (3 years (1-20), size at diagnosis: 25 mm (4-140)) and 39% had no surgery (3.6 years (1-23), 25.5 mm (1-200)). Surgical indications were (not exclusive) uncertain diagnosis (60%), symptoms (23%), size increase (12%), large size (6%) and adjacent organ compression (5%). In patients followed beyond 1 year (n=1271), size increased in 37% (growth rate: 4 mm/year), was stable in 57% and decreased in 6%. Three serous cystadenocarcinomas were recorded. Postoperative mortality was 0.6% (n=10), and SCN's related mortality was 0.1% (n=1). CONCLUSIONS: After a 3-year follow-up, clinical relevant symptoms occurred in a very small proportion of patients and size slowly increased in less than half. Surgical treatment should be proposed only for diagnosis remaining uncertain after complete workup, significant and related symptoms or exceptionally when exists concern with malignancy. This study supports an initial conservative management in the majority of patients with SCN. TRIAL REGISTRATION NUMBER: IRB 00006477. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
OBJECTIVES:Serous cystic neoplasm (SCN) is a cystic neoplasm of the pancreas whose natural history is poorly known. The purpose of the study was to attempt to describe the natural history of SCN, including the specific mortality. DESIGN: Retrospective multinational study including SCN diagnosed between 1990 and 2014. RESULTS: 2622 patients were included. Seventy-four per cent were women, and median age at diagnosis was 58 years (16-99). Patients presented with non-specific abdominal pain (27%), pancreaticobiliary symptoms (9%), diabetes mellitus (5%), other symptoms (4%) and/or were asymptomatic (61%). Fifty-two per cent of patients were operated on during the first year after diagnosis (median size: 40 mm (2-200)), 9% had resection beyond 1 year of follow-up (3 years (1-20), size at diagnosis: 25 mm (4-140)) and 39% had no surgery (3.6 years (1-23), 25.5 mm (1-200)). Surgical indications were (not exclusive) uncertain diagnosis (60%), symptoms (23%), size increase (12%), large size (6%) and adjacent organ compression (5%). In patients followed beyond 1 year (n=1271), size increased in 37% (growth rate: 4 mm/year), was stable in 57% and decreased in 6%. Three serous cystadenocarcinomas were recorded. Postoperative mortality was 0.6% (n=10), and SCN's related mortality was 0.1% (n=1). CONCLUSIONS: After a 3-year follow-up, clinical relevant symptoms occurred in a very small proportion of patients and size slowly increased in less than half. Surgical treatment should be proposed only for diagnosis remaining uncertain after complete workup, significant and related symptoms or exceptionally when exists concern with malignancy. This study supports an initial conservative management in the majority of patients with SCN. TRIAL REGISTRATION NUMBER: IRB 00006477. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
Authors: Rosalie A Carr; Michele T Yip-Schneider; Scott Dolejs; Bradley A Hancock; Huangbing Wu; Milan Radovich; C Max Schmidt Journal: J Am Coll Surg Date: 2017-05-18 Impact factor: 6.113
Authors: Tatsuo Hata; Marco Dal Molin; Seung-Mo Hong; Koji Tamura; Masaya Suenaga; Jun Yu; Hiraku Sedogawa; Matthew J Weiss; Christopher L Wolfgang; Anne Marie Lennon; Ralph H Hruban; Michael G Goggins Journal: Clin Cancer Res Date: 2017-02-01 Impact factor: 12.531