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HPB Surgery
Volume 2015 (2015), Article ID 847837, 5 pages
http://dx.doi.org/10.1155/2015/847837
Research Article

Surgery for Cystic Pancreatic Lesions in the Post-Sendai Era: A Single Institution Experience

1Department of Surgery, Technische Universität München, Ismaninger Strasse 22, 81675 Munich, Germany
2Department of Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany
3Department of Surgery, Koc University School of Medicine, Rumelifeneri Yolu, Sariyer, 34450 Istanbul, Turkey
4Department of Internal Medicine, Technische Universität München, Ismaninger Strasse 22, 81675 Munich, Germany
5Institute of Pathology, Technische Universität München, Ismaninger Strasse 22, 81675 Munich, Germany
6Institute of Pathology, Medical University of Innsbruck, Muellerstrasse 44, 6020 Innsbruck, Austria

Received 13 January 2015; Revised 13 March 2015; Accepted 14 March 2015

Academic Editor: Attila Olah

Copyright © 2015 Jörg Kleeff et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Introduction. The management of cystic pancreatic lesions has changed in recent years as a result of increasing knowledge of their biological behaviour, better diagnostic options, and international guidelines. Methods. Retrospective analysis of a cohort of 86 patients operated for cystic pancreatic lesions during a seven-year period (2007–2014). Results. Final histopathology revealed 53 intraductal papillary mucinous neoplasms (19 branch duct IPMNs, 15 mixed type IPMNs, and 19 main duct IPMNs), 14 serous and 13 mucinous cystic neoplasms, 3 solid pseudopapillary neoplasms, and 3 other lesions. 4 cases displayed high grade intraepithelial neoplasia and 2 cases displayed invasive cancer. A pylorus-preserving partial duodenopancreatectomy was carried out in 27 patients, a total pancreatectomy was carried out in 9 patients, a left resection was carried out in 42 patients, and segmental resections and enucleations were carried out in 4 patients each. Overall postoperative morbidity and mortality were 40% and 2.3%, respectively. The preoperative diagnosis of a specific cystic tumor was accurate in 79% of patients and 9 patients (10%) could have avoided surgery with the correct preoperative diagnosis. Conclusion. Cystic pancreatic lesions are still a diagnostic challenge, requiring a dedicated multidisciplinary approach. The rate of malignancy is relatively small, whereas postoperative morbidity is substantial, underscoring the importance of adequate patient selection considering both the risk of surgery and the long term risk of malignancy.