Sorveglianza e terapia chirurgica nei tumori cistici del pancreas. Analisi dei risultati su 253 casi.

Abstract

Background: In clinical practice, the number of observed pancreatic cystic lesions is increased in the last years. At the same time, we also had assisted to a better definition of their natural history and to a wide spread of CWRM or EUS as fiable preoperative diagnostic instruments. In fact, even if current guidelines for the management of pancreatic cystic neoplasms are based on the presence of symptoms and radiologic pattern, a certain degree of overlap between different lesions exists, and little is known about the factors who really influence the correct management. The main aim of this study is to identify the effect of a “dedicate surveillance program” in the management of patiens with pancreatic cystic neoplasm.

Methods: A retrospective analysis was undertaken of patients managed between 1990 and 2012. The “dedicate surveillance program” started in 2000. Demographics, clinical, radiological, surgical and pathological characteristics of the patients were collected prospectively in a dedicate database. We studied, as main outcome, the effects of the surveillance program in the population of observed patients. Secondary outcomes were: to identify the effects of this program on the surgical indications; to identify the percentage of preoperative diagnostic pitfalls; to assess the efficacy of the program in preoperatively diagnose pre-malignant lesions and to identify the effect of the program on the patient’s overall survival.

Results: We analyzed 253 patients. Regarding the primary end-point we found that the start of a “dedicate surveillance program” increased significantly the number of asymptomatic patients observed (OR 0.3) and the mean age of the population (OR 1.1). Moreover it was possible to observe smaller cystic lesions (OR 0.8) and a standard radiological workup was completed more frequently (OR 21). Regarding the secondary end points we found that the dedicate program did not increase the risk of surgery and it also reduced the percentage of preoperative diagnostic pitfalls. Moreover, the use of a standard radiological workup increased the probability to identify benign and pre-malignant lesions and it was associated with a better overall survival.

Conclusion: The start of a “dedicate surveillance program” had modified the characteristic of observed patients. The increasing number of patients who completed a standard radiological workup allowed us to detect pancreatic cystic lesions in a earlier phase of their natural history