Editorial
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Pathophysiol. May 15, 2015; 6(2): 29-32
Published online May 15, 2015. doi: 10.4291/wjgp.v6.i2.29
Cystic tumors of the pancreas: Opportunities and risks
Marco Del Chiaro, Caroline Verbeke
Marco Del Chiaro, Pancreatic Surgery Unit, Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institute at Center for Digestive Diseases, Karolinska University Hospital, 14186 Stockholm, Sweden
Caroline Verbeke, Department of Pathology, Institute of Clinical Medicine, University of Oslo, 0316 Oslo, Norway
Caroline Verbeke, Department of Pathology, Karolinska Institute, 14186 Stockholm, Sweden
Author contributions: Del Chiaro M and Verbeke C equally contributed to this paper.
Conflict-of-interest: None.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Marco Del Chiaro, MD, PhD, FACS, Associate Professor of Surgery, Head of Pancreatic Surgery Unit, Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institute at Center for Digestive Diseases, Karolinska University Hospital, K53, 14186 Stockholm, Sweden. marco.del.chiaro@ki.se
Telephone: +46-8-58580000 Fax: +46-8-58586366
Received: January 18, 2015
Peer-review started: January 20, 2015
First decision: February 7, 2015
Revised: February 21, 2015
Accepted: March 16, 2015
Article in press: March 18, 2015
Published online: May 15, 2015
Processing time: 100 Days and 18.5 Hours
Abstract

Pancreatic cystic neoplasms (PCNs) are a high prevalence disease. It is estimated that about 20% of the general population is affected by PCNs. Some of those lesions can progress till cancer, while others behave in a benign fashion. In particular intraductal papillary mucinous neoplasms of the pancreas can be considered as the pancreatic analogon to colonic polyps. Treatment of these precursor lesions at an early stage can potentially reduce pancreas cancer mortality and introduce a new “era” of preemptive pancreatic surgery. However, only few of those lesions have an aggressive behavior. The accuracy of preoperative diagnosis, i.e., the distinction between the various PCNs is around 60%, and the ability to predict the future outcome is also less accurate. For this reason, a significant number of patients are currently over-treated with an unnecessary, high-risk surgery. Furthermore, the majority of patients with PCN are on life-long follow-up with imaging modality, which has huge cost implications for the Health Care System for limited benefits considering that a significant proportion of PCNs are or behave like benign lesions. The current guidelines for the diagnosis and management of PCNs are more based on expert opinion than on evidence. For all those reasons, the management of cystic tumors of the pancreas remains a controversial area of pancreatology. On one hand, the detection of PCNs and the surgical treatment of pre-cancerous neoplasms can be considered a big opportunity to reduce pancreatic cancer related mortality. On the other hand, PCNs are associated with a considerable risk of under- or over- treatment of patients and incur high costs for the Health Care System.

Keywords: Pancreatic cystic neoplasms; Mucinous cystic neoplasia; Preemptive pancreatic surgery; Pancreas; Intraductal papillary mucinous neoplasia

Core tip: The present paper is an editorial focused on the critical problems regarding the management strategy of pancreatic cystic neoplasms (PCNs). Being a pre-cancerous condition in most of the cases, PCNs represent a unique opportunity to prevent pancreatic cancer and to develop preemptive pancreatic surgery programs. However, the lack of predictive factors of the behaviour of these lesions, the low accuracy of pre-operative diagnostics, and the limited knowledge regarding the natural history of those lesions, result in a substantial risk for under- and over-treatment of patients with PCN and represent a high cost factor for the Health Care organization. The paper underscores the critical importance of both the current management of PCNs and the need for future research.