23. Pancreatic Serous Cystadenoma: Tumor Growth Rates and Recommendations For Treatment
Jennifer F. Tseng, MD*, Andrew L. Warshaw, MD, Dushyant V. Sahani, MD*, Gregory Y. Lauwers, MD*, David W. Rattner, MD, Carlos Fernandez-del Castillo, MD*
Massachusetts General Hospital, Boston, MA
To define the natural history and optimal treatment of pancreatic serous cystadenoma.
Records of 106 patients with pancreatic serous cystadenoma (1976-2004) were evaluated for patient and tumor characteristics, diagnostic workup, treatment, and outcomes. Patients with serial imaging were identified and tumor growth curves were calculated.
Mean age was 61.5 years; women (n=80) were significantly younger (60 vs.67, p=0.018). Symptoms included abdominal pain (24%), fullness/mass (10%), jaundice (7%), and fatigue/malaise (6%). 40% were asymptomatic. Symptomatic and asymptomatic patients did not differ in age. Mean tumor diameter was 4.5+3.1 cm, which did not vary by location. Tumors <4cm were less symptomatic than tumors >4cm (22% vs.78%,p<0.001). Serial radiography was analyzed for 24 patients. The median growth rate was 0.60 cm/yr. For tumors <4cm at presentation (n=15), the rate was 0.12 cm/yr; for tumors >4cm (n=9), the rate was 1.98 cm/yr (p=0.0002;see figure). 80 patients underwent operation. No cystadenocarcinomas were identified. One perioperative death occurred from pulmonary embolism.
We report the largest experience and first serial growth measurements of pancreatic serous cystadenomas. Currently, nearly half are incidentally discovered. Tumors <4cm at presentation grow at a rate of 0.12 cm/yr, but tumors >4cm grow at nearly 2 cm/yr. We therefore recommend that patients with serous cystadenomas >4cm and reasonable life expectancies undergo resection, whereas patients with smaller asymptomatic lesions may be treated nonoperatively, with serial imaging.