[Fat Bear Science] Pancreatic cystic tumor, follow-up? Or surgery?

As people's health awareness increases, more and more pancreatic cystic tumors are detected during physical examinations. However, whether pancreatic cystic tumors need to be treated, how to treat them, and what to pay attention to after treatment often trouble patients.

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Li Dewei

Director of the Hepatobiliary and Pancreatic Tumor Center of the Affiliated Cancer Hospital of Chongqing University, chief physician, doctor of medicine, and master's supervisor.

He is good at laparoscopic, robotic and traditional pancreatic surgery (including duodenectomy, mid-pancreatectomy, and tail pancreatic resection); laparoscopic, robotic and traditional liver surgery (including complex liver lobe and liver segment resection); laparoscopic pancreatic, robotic and traditional biliary surgery (including biliary tumor and biliary stone surgery); and liver transplantation.

Clinic hours: Tuesday all day

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Shen Ai

Attending physician at the Hepatobiliary and Pancreatic Tumor Center of the Affiliated Tumor Hospital of Chongqing University, Doctor of Medicine, and master's supervisor.

Mainly engaged in basic and clinical research on hepatobiliary and pancreatic tumors. Can skillfully perform laparoscopic partial/semi-hepatectomy, laparoscopic radical resection of hilar cholangiocarcinoma, laparoscopic radical resection of gallbladder cancer, laparoscopic pancreaticoduodenectomy, laparoscopic distal pancreatectomy with spleen preservation, and pancreaticoduodenectomy combined with vascular replacement or/reconstruction, and other high-difficulty operations, and can also skillfully perform various puncture and ablation treatments under image guidance.

Early pancreatic cystic tumors are often found during physical examinations.

A cyst is a cystic lesion that contains fluid. Liver cysts and kidney cysts are the most common abdominal cysts, but pancreatic cysts, although rare, have been increasing in recent years.

Many people think that cysts are not a big deal. Indeed, most liver cysts and kidney cysts are benign diseases, but the nature of pancreatic cysts is very complicated, and there are both benign and malignant cysts.

Pancreatic cystic tumors are usually divided into mucinous cystadenomas and serous cystadenomas. Mucinous cystadenomas may become malignant. Early pancreatic cystic tumors have basically no symptoms and are often found during physical examinations. However, common symptoms of patients in the middle and late stages include upper abdominal pain, fullness after meals, masses, pyloric obstruction symptoms, nausea, vomiting, diarrhea, steatorrhea, weight loss, etc.

Conventional imaging examinations such as abdominal color Doppler ultrasonography, CT or MRI can detect pancreatic cystic tumors at an early stage. For atypical lesions, CT, MRI, MRCP or endoscopic ultrasound can be performed simultaneously to improve diagnostic accuracy.

Whether surgery is appropriate depends on many factors

Pancreatic cystic tumors cannot be eliminated by drugs, but not all pancreatic cystic tumors require surgery. Whether surgical treatment is needed is mainly based on the following points:

Tumor nature

Tumor location

Patient Condition

Willingness to treat

Follow-up conditions

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☆ Nature of tumor ☆

Most pancreatic cystic lesions are benign tumors, and surgical indications must be carefully determined. Surgery is recommended for pancreatic tumors with obvious symptoms and confirmed or suspected malignancy.

If the tumor is smaller than 3 cm and has no obvious symptoms, and the tumor tissue biopsy shows that it is benign, then only close observation is required.

If the tumor diameter is larger than 3 cm or there are obvious symptoms, active surgical treatment is recommended.

If the tumor grows rapidly during the follow-up period, CA199 increases, imaging shows irregular cyst wall septa, cyst wall calcification, cyst wall enhancement, etc., all of which indicate malignant potential, and cyst fluid analysis confirms that it is malignant, early surgery is also recommended.

☆ Tumor location ☆

In addition to the nature of the tumor, the location of the tumor is also one of the factors that need to be considered when deciding whether to perform surgery. If the tumor is located in the pancreatic body and tail, the risk of postoperative complications is relatively small, but if the tumor is located in the pancreatic head, the postoperative period is difficult and the risk of complications is greater.

☆Patient Condition☆

Pancreatic cystic tumors are a type of disease that has a benign onset and has a tendency to become malignant but develops slowly. If the patient is older and in poor general condition, conservative treatment such as follow-up observation can be adopted. If the patient is young and in good general condition, active treatment is recommended to reduce the risk of tumor malignancy.

☆ Treatment willingness and follow-up conditions☆

If the patient's psychological pressure is too great and affects his daily life, active treatment can be adopted. If the patient's follow-up conditions are poor and he does not have the conditions for regular follow-up examinations, active treatment is also recommended.

Patients who did not undergo surgery were followed up every six months.

Pancreatic cystic tumors are generally asymptomatic and do not require much special attention. Patients can work, live and socialize normally and only need regular follow-up.

The principle of postoperative follow-up is determined by the results of postoperative pathological examination. If the postoperative pathological examination indicates benign disease, a routine physical examination is sufficient. If the postoperative pathological examination indicates malignant disease, regular follow-up examination is required according to the principle of follow-up for malignant tumors.

For pancreatic cystic tumors that do not require surgical resection, regular follow-up is required, and CT, MRI, or endoscopic ultrasound examinations are recommended every six months. Conventional B-ultrasound may affect the evaluation effect because the pancreas is a retroperitoneal organ and intestinal gas interference.

Minimally invasive or robotic surgery has advantages

The current surgical methods include laparotomy, laparoscopy and robotic surgery. Since most pancreatic cystic tumors are benign tumors, lymph node dissection is generally not required, and minimally invasive surgery such as laparoscopy or robotic surgery is recommended. Minimally invasive surgery causes less trauma, quicker recovery, and significantly reduces hospital stay. Compared with the 4-6 times magnification of the traditional laparoscopic field of view, the robot's field of view magnification is 10 times or even higher, with clearer anatomical structures, more flexible and precise operations, and a lower risk of postoperative complications, which is especially suitable for surgery to preserve pancreatic function.

A common complication after pancreatic surgery is pancreatic fistula. Pancreatic fistula after pancreatic body and tail tumors or pancreatic tumor enucleation is less harmful, while pancreatic fistula after pancreatoduodenectomy for pancreatic head tumors is more harmful. With the standardization of surgical procedures, minimally invasive and refined surgical techniques, and standardized perioperative management, the incidence of complications after pancreatic surgery has been significantly reduced, and the harm has been significantly reduced. Since the incidence of pancreatic cystic tumor lesions is relatively low, the operation has a greater risk and the treatment of complications requires refined management by experienced hepatobiliary and pancreatic surgeons. It is recommended that patients with pancreatic cystic tumors see experienced hepatobiliary and pancreatic surgeons.

What should I pay attention to in my diet after surgery?

The most common symptoms of pancreatic cystic tumor patients after surgery are loss of appetite, abdominal distension, and easy feeling of fullness, which will improve over time. It is recommended that patients eat small meals frequently to ensure a balanced daily nutrition. It is recommended that patients quit smoking, drinking, coffee, strong tea, spicy foods, carbonated drinks, etc., chew slowly, and eat light and easily digestible food.

The main function of the pancreas is to secrete various hormones and digestive enzymes, which are the so-called endocrine and exocrine functions. The function of the pancreas may be affected after surgery, and high blood sugar, indigestion, diarrhea, and weight loss often occur. The diet structure can be adjusted, and insulin injections and oral pancreatic enzyme tablets can be used for replacement therapy when necessary. However, long-term drug maintenance has a greater impact on the patient's quality of life, so it is advisable to choose surgery to preserve pancreatic function as much as possible.

Summarize

We summarize in three points.

First of all, pancreatic cystic tumors are benign in onset. When a pancreatic cystic tumor is found during a physical examination, there is no need to be overly anxious. It is key to clarify the nature of the pancreatic cystic tumor. Choosing an individualized treatment plan can maximize the long-term benefits for patients.

Secondly, the identification of pancreatic cystic tumors determines whether the patient should be followed up or treated surgically, and whether the surgical treatment should be open surgery or minimally invasive surgery. Therefore, after the patient is diagnosed with pancreatic cystic tumors, he or she should go to the hepatobiliary and pancreatic surgery department with rich experience for individualized diagnosis and treatment.

Finally, patients must follow their doctor’s orders for follow-up visits and not ignore the disease simply because it is found to be benign.

Text/Fat Bear

Picture/partially from the Internet (please contact us to delete if there is any infringement)

Audit/Hepatobiliary and Pancreatic Cancer Center

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