Cystic Neoplasms of the Pancreas: Diagnostic Approach and Modern Surgical Management
Cystic neoplasms of the pancreas are a special category of pancreatic tumors and are divided into three categories, IPMN (or intraductal papillary mucinous neoplasms), mucinous and serous cystic neoplasms.
They are diagnosed due to symptomatology and investigation or as incidental imaging findings. Their management should be individualized following established international guidelines. Symptoms that these tumors may present include nausea, vomiting, abdominal pain, feeling of heaviness and others.
The diagnostic approach that follows their discovery includes magnetic resonance imaging and computed tomography in some cases and, depending on the characteristics of the tumor, further clarification using endoscopic ultrasound. It is particularly important that these cases are managed by a specialist team that includes, in addition to the surgeon, a trained radiologist and gastroenterologist.
Having personally served as head of the oncology board at the Royal London Hospital in London where we discussed and determined the treatment for a large number of cystic neoplasms every week, I can say with certainty that interdisciplinary collaboration is essential to achieve an excellent outcome. A cystic neoplasm of the pancreas can develop into an aggressive adenocarcinoma, so early diagnosis and surgical treatment are of particular importance.
The surgical procedure involves the resection of the tumor with the corresponding part of the pancreas. Depending on the location of the cystic neoplasm, the patient will undergo a Whipple operation (pancreatoduodenectomy) or a peripheral pancreatectomy. Depending on the location and nature of the tumor, the peripheral pancreatectomy will be performed with preservation of the spleen.
The approach can be laparoscopic, open or robotic, depending on the case, and minimally invasive surgery offers the advantages of a faster recovery of the patient with more immediate mobilization and function of the gastrointestinal system. The presence of a diabetologist is also necessary in the specialized team, since there may be the appearance of temporary or long-term diabetes mellitus.
In conclusion, it is important that the treatment from the beginning to the final solution is carried out by a specialized surgeon in the field of pancreas – liver – biliary tract, as is the case abroad, and ideally in a center that can support with diagnostic and operational means.
