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Liang X, Gu Y, Chen Y, Liu Y, Wang S, Fu Y. Laparoscopic Duodenum-Preserving Pancreatic Head Resection: A Technique for the Treatment of Benign or Low-Grade Malignant Tumors (10 Cases Report). J Laparoendosc Adv Surg Tech A 2024; 34:135-140. [PMID: 38170176 DOI: 10.1089/lap.2023.0381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024] Open
Abstract
Background: Laparoscopic duodenum-preserving pancreatic head resection (LDPPHR) is a surgical procedure that involves the removal of the pancreatic head while aiming to preserve the integrity of the digestive and biliary tracts. With advancements in laparoscopic techniques, the utilization of LDPPHR has been increasing. Methods: We retrospectively analyzed the clinical data of 10 patients who underwent laparoscopic duodenum-preserving total pancreatic head resection (LDPPHR-t) at our center from June 2019 to October 2021. Additionally, we analyzed the use of indocyanine green (ICG) in the initial stage of LDPPHR, based on current reports. Results: LDPPHR-t was successfully performed in all patients. After surgery, 3 patients experienced pancreatic fistula (Grade B), 2 patients experienced bile leakage, and 2 patients experienced postoperative hemorrhage. However, no patient exhibited recurrence or required secondary surgery. Conclusion: LDPPHR-t is a new method for treating benign and low-grade malignant tumors in the pancreatic head. However, it is associated with a high incidence of postoperative complications. In the initial stage, the use of ICG can assist surgeons in identifying the biliary duct and pancreaticoduodenal artery arcade.
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Affiliation(s)
- Xue Liang
- Departmento of Hepatobiliary and Pancreatic Surgery, General Surgery Center, First Hospital of Jilin University, Changchun, China
| | - Yu Gu
- Departmento of Hepatobiliary and Pancreatic Surgery, General Surgery Center, First Hospital of Jilin University, Changchun, China
| | - Yunyun Chen
- Departmento of Hepatobiliary and Pancreatic Surgery, General Surgery Center, First Hospital of Jilin University, Changchun, China
| | - Yahui Liu
- Departmento of Hepatobiliary and Pancreatic Surgery, General Surgery Center, First Hospital of Jilin University, Changchun, China
| | - Shupeng Wang
- Departmento of Hepatobiliary and Pancreatic Surgery, General Surgery Center, First Hospital of Jilin University, Changchun, China
| | - Yu Fu
- Departmento of Hepatobiliary and Pancreatic Surgery, General Surgery Center, First Hospital of Jilin University, Changchun, China
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Vicente E, Quijano Y, Caruso R, Duran H, Diaz E, Ferri V. Pancreatic head resection with segmental duodenectomy for the treatment of benign and malign pancreatic diseases. Case series experience of a single center. Int J Surg Case Rep 2023; 106:108240. [PMID: 37137172 PMCID: PMC10165390 DOI: 10.1016/j.ijscr.2023.108240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 04/12/2023] [Accepted: 04/14/2023] [Indexed: 05/05/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Duodenum-preserving pancreatic resections (DPPHR) is a reasonable surgical option for benign or low-grade malignant tumours of the pancreatic head. Several techniques have been proposed, with or without common biliary duct preservation. CASE PRESENTATION We report for the first time two cases of pancreas divisum treated with this technique and we illustrate two other cases of pancreatic disease in which this procedure was realized from January 2015 to January 2020 in the HM Sanchinarro University Hospital. CLINICAL DISCUSSION Pancreatic head resection with pancreatic parenchyma sparing, and duodenal preservation has been commonly accepted in the treatment of benign pancreatic head disease. CONCLUSION This technique offers a wide application in the treatment of pancreatic and duodenal benign disease, including pancreatic malformation such as pancreas divisum and duodenal tumour that require segmental resection, in order to assure complete pancreatic head resection and to avoid duodenal and biliary duct ischemia.
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Affiliation(s)
- Emilio Vicente
- Sanchinarro University Hospital, General Surgery Department, San Pablo University, CEU, Madrid, Spain
| | - Yolanda Quijano
- Sanchinarro University Hospital, General Surgery Department, San Pablo University, CEU, Madrid, Spain
| | - Riccardo Caruso
- Sanchinarro University Hospital, General Surgery Department, San Pablo University, CEU, Madrid, Spain.
| | - Hipolito Duran
- Sanchinarro University Hospital, General Surgery Department, San Pablo University, CEU, Madrid, Spain
| | - Eduardo Diaz
- Sanchinarro University Hospital, General Surgery Department, San Pablo University, CEU, Madrid, Spain
| | - Valentina Ferri
- Sanchinarro University Hospital, General Surgery Department, San Pablo University, CEU, Madrid, Spain
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Zhang Y, Zhang J, Jiang K, Wu W. Indocyanine green real-time-guided laparoscopic duodenum-preserving pancreatic head resection. J Minim Access Surg 2022; 18:632-634. [PMID: 36124475 PMCID: PMC9632711 DOI: 10.4103/jmas.jmas_205_21] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Duodenum-preserving pancreatic head resection (DPPHR) is very complicated due to its difficulty to find the lower common bile duct (CBD), and to preserve the blood supply of the duodenum and CBD. Recently, indocyanine green (ICG) has been widely applied for navigation during biliary system and liver surgery. However, the application of ICG-guided laparoscopic DPPHR has not been established. Herein, we report an intraoperative angiography technique using ICG fluorescence imaging to visualise blood flow, tissue perfusion, CBD navigation and bile leakage assessment.
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Affiliation(s)
- Yuanbiao Zhang
- Department of Hepatobiliary and Pancreatic Surgery, School of Medicine, The Second Affiliated Hospital, Zhejiang University; Department of Hepatobiliary and Pancreatic Surgery and Minimally Invasive Surgery, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Jungang Zhang
- Department of Hepatobiliary and Pancreatic Surgery and Minimally Invasive Surgery, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Kai Jiang
- Department of Hepatobiliary and Pancreatic Surgery and Minimally Invasive Surgery, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Weiding Wu
- Department of Hepatobiliary and Pancreatic Surgery and Minimally Invasive Surgery, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, Zhejiang; Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
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Chen S, Gao P, Cai H, Cai Y, Wang X, Peng B. Indocyanine Green-Enhanced Fluorescence in Laparoscopic Duodenum-Preserving Pancreatic Head Resection: Technique with Video. Ann Surg Oncol 2020; 27:3926-3927. [PMID: 32266569 DOI: 10.1245/s10434-020-08360-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND In 1972, Beger et al.1 first described duodenum-preserving pancreatic head resection (DPPHR) for patients with severe chronic pancreatitis. Then DPPHR also was proved capable of providing comparable long-term oncologic outcomes in the setting of benign or low-grade malignant tumors.2 As an organ-preserving procedure, DPPHR preserves the integrity of the digestive tract and improves the patient's quality of life compared with pancreaticoduodenectomy (PD),3 although DPPHR is more technically challenging, especially in protecting the bile duct and the pancreaticoduodenal vascular arch.4,5 The indocyanine green (ICG)-enhanced fluorescence imaging system in laparoscopic surgery can identify the biliary and vascular anatomy clearly to ensure a safe cholecystectomy and an adequate vascular supply for colectomy or nephrectomy.6 Nevertheless, to date, no report has described ICG-enhanced fluorescence in laparoscopic duodenum-preserving pancreatic head resection (LDPPHR). This article describes the technique of LDPPHR using a video of a real-time ICG fluorescence imaging system. METHODS A 29-year-old woman received a diagnosis of chronic pancreatitis and an inflammatory mass in the head of the pancreas. A computed tomography (CT) scan showed atrophy of the pancreas, dilation of the main pancreatic duct, and heterogeneous enhancement of the pancreatic head parenchyma (Fig. 1). Her other preoperative examination results were normal except for high blood sugar. To avoid an extended PD for this young patient, LDPPHR was performed. The patient was placed in supine position with her two legs apart. The observing trocar (10 mm) was located at the inferior umbilicus. Four trocars (two 5-mm trocars and two 12-mm trocars) were distributed symmetrically at the midclavicular line and anterior axillary line. Another 5-mm trocar located at the subxiphoid was used for traction of the stomach with a rubber band. Before the operation, ICG (5 mg) was injected intravenously from the elbow vein. The gastrocolic ligament was opened, and the hepatic flexure of the colon was taken down to explore the head of the pancreas without making a Kocher's maneuver. After hanging of the distal stomach with a rubber band, both the right gastroepiploic vein and Henle's trunk were dissected. The number 8a lymph node was dissected for intraoperative rapid frozen pathology. A post-pancreatic neck tunnel was built, and the pancreatic neck was transected with an ultrasonic scalpel. The main pancreatic duct was identified and transected with cold scissors. The superior mesenteric vein (SMV) was hung with another rubber band and retracted to the left. The uncinate process of the pancreas was retracted to the right, and subcapsular dissection was performed, with particular attention paid to protection of the anterior inferior pancreaticoduodenal artery (AIPDA), the posterior inferior pancreaticoduodenal artery (PIPDA), and their branches that go into the duodenum. Then the gastroduodenal artery (GDA) was identified, and the anterosuperior pancreatic duodenal artery (ASPDA) was dissected. The upper part of the pancreatic head was separated to expose the common bile duct (CBD) with the help of real-time ICG fluorescence imaging (Fig. 2). The pancreas was dissected from the left edge of the duodenum and the right and ventral edges of the CBD. The posterosuperior pancreatic duodenal artery (PSPDA) was identified at the dorsal edge of the CBD. The PSPDA and its branches going into the distal CBD as well as the ampulla of Vater were carefully preserved. The proximal side of the main and accessory pancreatic duct was identified and sutured. Pancreatic anastomosis was performed using the technique of Bing's anastomosis.7 Fig. 1 Enhanced computed tomography (CT) scan showing atrophy of the pancreas, dilatation of the main pancreatic duct, and heterogeneous enhancement of the pancreatic head parenchyma Fig. 2 The common bile duct was separated and exposed from the head to the tail by the assistance of the real-time indocyanine green (ICG)-enhanced fluorescence imaging system RESULTS: The operation time was 251 min, and the estimated blood loss was 150 ml. The postoperative course was uneventful, with a hospital stay of 13 days. From February 2019 to November 2019, LDPPHR was used by the authors to manage 24 cases, including chronic pancreatitis (6 cases), pancreatic intraductal papillary mucinous tumors (6 cases), pancreatic neuroendocrine tumors (4 cases), pancreatic solid pseudopapillary tumors (4 cases), serous cystadenoma (3 cases), and mucinous cystadenoma (1 case). CONCLUSIONS Indocyanine green-enhanced fluorescence in laparoscopic duodenum-preserving pancreatic head resection was safe and may offer a benefit for maintaining the integrity of the biliary system.
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Affiliation(s)
- Sirui Chen
- Department of Hepatobiliary Surgery, Mianyang Central Hosptial, Mianyang, China
| | - Pan Gao
- Department of Minimal Invasive Surgery, Shangjin Nanfu Hosptial, Chengdu, China.,Department of Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - He Cai
- Department of Minimal Invasive Surgery, Shangjin Nanfu Hosptial, Chengdu, China.,Department of Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yunqiang Cai
- Department of Minimal Invasive Surgery, Shangjin Nanfu Hosptial, Chengdu, China.,Department of Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Xin Wang
- Department of Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Bing Peng
- Department of Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu, China.
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Ferri V, Vicente E, Quijano Y, Ielpo B, Duran H, Diaz E, Fabra I, Caruso R. Diagnosis and treatment of pancreas divisum: A literature review. Hepatobiliary Pancreat Dis Int 2019; 18:332-336. [PMID: 31155429 DOI: 10.1016/j.hbpd.2019.05.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 05/13/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND Pancreas divisum is a congenital embryological disease caused by a lack of fusion between the ventral and dorsal pancreatic ducts in the early stages of embryogenesis. Recurrent acute pancreatitis, chronic pancreatitis or chronic abdominal pain are the main clinical syndromes at presentation and occur in only 5% of the patients with pancreas divisum. This review aimed to discuss diagnosis and treatment strategies in patients with symptomatic pancreas divisum. DATA SOURCES We report a literature review from 1990 up to January 2018 to explore the various diagnostic modalities and surgical techniques and results reported in the surgical treatment of pancreas divisum. RESULTS There are limited reports available on this topic in the literature. We analyzed and described the main indications in the treatment of pancreas divisum, focusing on surgical treatment and a discussion of the different approaches. Furthermore, we report the results from our experience in two cases of pancreas divisum treated by pancreatic head resection with segmental duodenectomy (the Nakao procedure). CONCLUSIONS Pancreas divisum is a common pancreatic malformation in which only a few patients develop a symptomatic disease. Surgical treatment is needed in case of endoscopic drainage failure and in cases complicated with chronic pancreatitis and local complications. Many techniques, of greater or lesser complexity, have been proposed.
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Affiliation(s)
- Valentina Ferri
- Division of General Surgery, Sanchinarro Hospital, San Pablo University, calle oña 10, 28050 Madrid, Spain.
| | - Emilio Vicente
- Division of General Surgery, Sanchinarro Hospital, San Pablo University, calle oña 10, 28050 Madrid, Spain
| | - Yolanda Quijano
- Division of General Surgery, Sanchinarro Hospital, San Pablo University, calle oña 10, 28050 Madrid, Spain
| | - Benedetto Ielpo
- Division of General Surgery, Sanchinarro Hospital, San Pablo University, calle oña 10, 28050 Madrid, Spain
| | - Hipolito Duran
- Division of General Surgery, Sanchinarro Hospital, San Pablo University, calle oña 10, 28050 Madrid, Spain
| | - Eduardo Diaz
- Division of General Surgery, Sanchinarro Hospital, San Pablo University, calle oña 10, 28050 Madrid, Spain
| | - Isabel Fabra
- Division of General Surgery, Sanchinarro Hospital, San Pablo University, calle oña 10, 28050 Madrid, Spain
| | - Riccardo Caruso
- Division of General Surgery, Sanchinarro Hospital, San Pablo University, calle oña 10, 28050 Madrid, Spain
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Cao J, Li GL, Wei JX, Yang WB, Shang CZ, Chen YJ, Lau WY, Min J. Laparoscopic duodenum-preserving total pancreatic head resection: a novel surgical approach for benign or low-grade malignant tumors. Surg Endosc 2018; 33:633-638. [PMID: 30456509 DOI: 10.1007/s00464-018-6488-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Accepted: 10/11/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND Duodenum-preserving total pancreatic head resection (DPPHRt) is an accepted alternative surgical procedure for benign or low-grade malignant tumors of the pancreatic head by preserving the duodenum with its intact blood supply from the pancreatic duodenal arterial arcade. This study describes our experience in laparoscopic DPPHRt (LDPPHRt). To our knowledge, this is the first description of this novel minimally invasive operation. METHODS From August 2016 to May 2017, all consecutive patients who underwent LDPPHRt for pancreatic head lesions at the HPB Surgery Department, Sun Yat-Sen Memorial Hospital in Guangzhou, China were enrolled into this retrospective study. RESULTS There were ten women and two men. The average age was 37.3 years (range 8-61 years). The average diameter of the pancreatic head lesions on pre-operative CT/MR was 3.7 cm (range 2-4.8 cm). All the LDPPHRt procedures were performed successfully. There was no peri-operative death. The average operative time was 272.5 min (range 210-320 min). The average blood loss was 215 ml (range 50-450 ml). Post-operative complications included pancreatic fistula grade B (two patients, or 16.7%) and biliary fistula (two patients, or 16.7%). All the complications responded well to conservative treatment. The mean post-operative hospital stay was 11.5 days (range 6-25 days). CONCLUSIONS LDPPHRt provided a minimally invasive approach with good organ-preservation for benign or low-grade malignant tumors of the pancreatic head. The long-term oncological outcomes, and the exocrine and endocrine pancreatic functions after this operation require further studies.
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Affiliation(s)
- Jun Cao
- Department of Hepatobiliopancreatic Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Yanjiangxi Road 107#, Guangzhou, China
| | - Guo-Lin Li
- Department of Hepatobiliopancreatic Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Yanjiangxi Road 107#, Guangzhou, China
| | - Jin-Xing Wei
- Department of Hepatobiliopancreatic Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Yanjiangxi Road 107#, Guangzhou, China
| | - Wei-Bang Yang
- Department of Hepatobiliopancreatic Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Yanjiangxi Road 107#, Guangzhou, China
| | - Chang-Zhen Shang
- Department of Hepatobiliopancreatic Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Yanjiangxi Road 107#, Guangzhou, China
| | - Ya-Jin Chen
- Department of Hepatobiliopancreatic Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Yanjiangxi Road 107#, Guangzhou, China
| | - Wan Yee Lau
- Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong.
| | - Jun Min
- Department of Hepatobiliopancreatic Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Yanjiangxi Road 107#, Guangzhou, China.
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Zhou J, Zhou Y, Mou Y, Xia T, Xu X, Jin W, Zhang R, Lu C, Chen R. Laparoscopic duodenum-preserving pancreatic head resection: A case report. Medicine (Baltimore) 2016; 95:e4442. [PMID: 27512859 PMCID: PMC4985314 DOI: 10.1097/md.0000000000004442] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Solid pseudopapillary neoplasms (SPNs) of the pancreas are uncommon neoplasms and are potentially malignant. Complete resection is advised due to rare recurrence and metastasis. Duodenum-preserving pancreatic head resection (DPPHR) is indicated for SPNs located in the pancreatic head and is only performed using the open approach. To the best of our knowledge, there are no reports describing laparoscopic DPPHR (LDPPHR) for SPNs. METHODS Herein, we report a case of 41-year-old female presented with a 1-week history of epigastric abdominal discomfort, and founded an SPN of the pancreatic head by abdominal computed tomography/magnetic resonance, who was treated by radical LDPPHR without complications, such as pancreatic fistula and bile leakage. Histological examination of the resected specimen confirmed the diagnosis of SPN. RESULTS The patient was discharged 1 week after surgery following an uneventful postoperative period. She was followed up 3 months without readmission and local recurrence according to abdominal ultrasound. CONCLUSION LDPPHR is a safe, feasible, and effective surgical procedure for SPNs.
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Affiliation(s)
- Jiayu Zhou
- Department of General Surgery, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Yucheng Zhou
- Department of General Surgery, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang Province, China
| | - Yiping Mou
- Department of General Surgery, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang Province, China
| | - Tao Xia
- Department of General Surgery, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Xiaowu Xu
- Department of General Surgery, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang Province, China
| | - Weiwei Jin
- Department of General Surgery, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Renchao Zhang
- Department of General Surgery, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang Province, China
| | - Chao Lu
- Department of General Surgery, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Ronggao Chen
- Department of General Surgery, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
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Abstract
Surgical resection is recommended for all mucinous cystic neoplasms (MCNs) of the pancreas as a result of: 1) lack of an accurate tumor marker for invasive cancer; 2) young age at diagnosis; and 3) historical studies revealing 36 per cent incidence of malignancy in resected lesions. This study compares the clinicopathologic and prognostic features of our series of resected MCNs to recent studies using the current International Association of Pancreatology (IAP) system. Thirty-eight resected MCNs were identified. Almost all patients were female (97.4%); median age at diagnosis was 53.5 years (interquartile range [IQR], 41.3 to 61.0). The majority occurred in the body/tail of the pancreas (86.8%); median size on computed tomography/magnetic resonance imaging was 5.0 cm (IQR, 3 to 8.8). Comparison of the five high-grade (HG, 13.2%) and 33 low-grade (86.8%) MCNs revealed that 1) patients were similar in age (55.0 vs 52.0 years, respectively) and 2) HG lesions were significantly larger on preoperative imaging (9.9 vs 3.5 cm) and final pathology (10.9 vs 3.5 cm). These data, taken together with five recent studies that adhere to the 2012 IAP criteria (385 total MCNs), reveal that a cutoff of less than 3 cm without mural nodules would have only missed one (0.26%) HG lesion. Surveillance of these lesions may be appropriate for some patients.
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