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

260 Citations (Scopus)

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 (US)
Pages (from-to)571-579
Number of pages9
JournalAnnals of surgery
Volume247
Issue number4
DOIs
StatePublished - Apr 1 2008

Fingerprint

Pancreatic Neoplasms
Neoplasms
Carcinoma
Adenoma
Pancreatic Ducts
Carcinoma in Situ
Pancreatitis
Ovarian Neoplasms
Abdominal Pain
Pancreas
Communication

ASJC Scopus subject areas

  • Surgery

Cite this

Crippa, S., Salvia, R., Warshaw, A. L., Domínguez, I., Bassi, C., Falconi, M., ... 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

Mucinous cystic neoplasm of the pancreas is not an aggressive entity : Lessons from 163 resected patients. / Crippa, Stefano; Salvia, Roberto; Warshaw, Andrew L.; Domínguez, Ismael; Bassi, Claudio; Falconi, Massimo; Thayer, Sarah P; Zamboni, Giuseppe; Lauwers, Gregory Y.; Mino-Kenudson, Mari; Capelli, Paola; Pederzoli, Paolo; Castillo, Carlos Fernández Del.

In: Annals of surgery, Vol. 247, No. 4, 01.04.2008, p. 571-579.

Research output: Contribution to journalArticle

Crippa, S, Salvia, R, Warshaw, AL, Domínguez, I, Bassi, C, Falconi, M, Thayer, SP, Zamboni, G, Lauwers, GY, Mino-Kenudson, M, Capelli, P, Pederzoli, P & Castillo, CFD 2008, 'Mucinous cystic neoplasm of the pancreas is not an aggressive entity: Lessons from 163 resected patients', Annals of surgery, vol. 247, no. 4, pp. 571-579. https://doi.org/10.1097/SLA.0b013e31811f4449
Crippa, Stefano ; Salvia, Roberto ; Warshaw, Andrew L. ; Domínguez, Ismael ; Bassi, Claudio ; Falconi, Massimo ; Thayer, Sarah P ; Zamboni, Giuseppe ; Lauwers, Gregory Y. ; Mino-Kenudson, Mari ; Capelli, Paola ; Pederzoli, Paolo ; Castillo, Carlos Fernández Del. / Mucinous cystic neoplasm of the pancreas is not an aggressive entity : Lessons from 163 resected patients. In: Annals of surgery. 2008 ; Vol. 247, No. 4. pp. 571-579.
@article{900941faf77c452d9559d0f92582e420,
title = "Mucinous cystic neoplasm of the pancreas is not an aggressive entity: Lessons from 163 resected patients",
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.",
author = "Stefano Crippa and Roberto Salvia and Warshaw, {Andrew L.} and Ismael Dom{\'i}nguez and Claudio Bassi and Massimo Falconi and Thayer, {Sarah P} and Giuseppe Zamboni and Lauwers, {Gregory Y.} and Mari Mino-Kenudson and Paola Capelli and Paolo Pederzoli and Castillo, {Carlos Fern{\'a}ndez Del}",
year = "2008",
month = "4",
day = "1",
doi = "10.1097/SLA.0b013e31811f4449",
language = "English (US)",
volume = "247",
pages = "571--579",
journal = "Annals of Surgery",
issn = "0003-4932",
publisher = "Lippincott Williams and Wilkins",
number = "4",

}

TY - JOUR

T1 - Mucinous cystic neoplasm of the pancreas is not an aggressive entity

T2 - Lessons from 163 resected patients

AU - Crippa, Stefano

AU - Salvia, Roberto

AU - Warshaw, Andrew L.

AU - Domínguez, Ismael

AU - Bassi, Claudio

AU - Falconi, Massimo

AU - Thayer, Sarah P

AU - Zamboni, Giuseppe

AU - Lauwers, Gregory Y.

AU - Mino-Kenudson, Mari

AU - Capelli, Paola

AU - Pederzoli, Paolo

AU - Castillo, Carlos Fernández Del

PY - 2008/4/1

Y1 - 2008/4/1

N2 - 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.

AB - 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.

UR - http://www.scopus.com/inward/record.url?scp=41149135288&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=41149135288&partnerID=8YFLogxK

U2 - 10.1097/SLA.0b013e31811f4449

DO - 10.1097/SLA.0b013e31811f4449

M3 - Article

VL - 247

SP - 571

EP - 579

JO - Annals of Surgery

JF - Annals of Surgery

SN - 0003-4932

IS - 4

ER -