Mucinous cystic neoplasm of the pancreas is not an aggressive entity: Lessons from 163 resected patients

Stefano Crippa, Roberto Salvia, Andrew L. Warshaw, Ismael Domínguez, Claudio Bassi, Massimo Falconi, Sarah P. Thayer, Giuseppe Zamboni, Gregory Y. Lauwers, Mari Mino-Kenudson, Paola Capelli, Paolo Pederzoli, Carlos Fernández Del Castillo

Research output: Contribution to journalArticle

Abstract

OBJECTIVE: Mucinous cystic neoplasms (MCNs) of the pancreas have often been confused with intraductal papillary mucinous neoplasms. We evaluated the clinicopathologic characteristics, prevalence of cancer, and prognosis of a large series of well-characterized MCNs in 2 tertiary centers. METHODS: Analysis of 163 patients with resected MCNs, defined by the presence of ovarian stroma and lack of communication with the main pancreatic duct. RESULTS: MCNs were seen mostly in women (95%) and in the distal pancreas (97%); 25% were incidentally discovered. Symptomatic patients typically had mild abdominal pain, but 9% presented with acute pancreatitis. One hundred eighteen patients (72%) had adenoma, 17 (10.5%) borderline tumors, 9 (5.5%) in situ carcinoma, and 19 (12%) invasive carcinoma. Patients with invasive carcinoma were significantly older than those with noninvasive neoplasms (55 vs. 44 years, P = 0.01). Findings associated with malignancy were presence of nodules (P = 0.0001) and diameter ≥60 mm (P = 0.0001). All neoplasms with cancer were either ≥40 mm in size or had nodules. There was no operative mortality and postoperative morbidity was 49%. Median follow-up was 57 months (range, 4-233); only patients with invasive carcinoma had recurrence. The 5-year disease-specific survival for noninvasive MCNs was 100%, and for those with invasive cancer, 57%. CONCLUSIONS: This series, the largest with MCNs defined by ovarian stroma, shows a prevalence of cancer of only 17.5%. Patients with invasive carcinoma are older, suggesting progression from adenoma to carcinoma. Although resection should be considered for all cases, in low-risk MCNs (≤4 cm/no nodules), nonradical resections are appropriate.

Original languageEnglish
Pages (from-to)571-579
Number of pages9
JournalAnnals of Surgery
Volume247
Issue number4
DOIs
Publication statusPublished - Apr 2008

ASJC Scopus subject areas

  • Surgery

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    Crippa, S., Salvia, R., Warshaw, A. L., Domínguez, I., Bassi, C., Falconi, M., Thayer, S. P., Zamboni, G., Lauwers, G. Y., Mino-Kenudson, M., Capelli, P., Pederzoli, P., & Castillo, C. F. D. (2008). Mucinous cystic neoplasm of the pancreas is not an aggressive entity: Lessons from 163 resected patients. Annals of Surgery, 247(4), 571-579. https://doi.org/10.1097/SLA.0b013e31811f4449