Mucinous Cystic Neoplasm Of The Pancreas : An Analysis Of 42 Patients

Objective:To investigate the clinicopathological characteristics,treatment,prognosis of mucinous cystic neoplasm(MCN)and risk factors associated with invasive MCN based on 6-year experience in the management of this rare neoplasm in a single institution to improve the understanding of MCN.Methods:Retrospective analysis was made on the clinicopathological data,including general information,preoperative serological examination data and image examination data of 42 patients operated in The First Hospital of Jilin University with pathologically confirmed mucinous cystic neoplasm(MCN).According to the postoperative pathological diagnosis,the patients were divided into invasive MCN group and noninvasive MCN group(including high,middle,low-grade dysplasia).Two-tailed t tests were used to compare parametric data,whereas Mann-Whitney U tests were used for assessment of nonparametric data.Comparisons of categorical variables were conducted with χ2 or Fisher exact tests.Associations between preoperative factors and invasive MCN were determined with univariate binary logistic regression analysis.Variables with a statistically significant association on univariate analysis were included in a multivariable binary logistic regression model.Results:42 patients,4 males and 38 females,were included in this study,with a male-to-female ratio about 1:9.5.The average age of patients was 44.6 years.The number of MCN found by physical examination was 16,with no typical symptoms and signs before surgery.Abdominal pain or distension was described as the main symptom by 14 patients(33.33%).Neoplasms were located predominantly in the body and tail of the pancreas(88.10%)with a mean size of 6.03 cm.Preoperative serum CEA,and CA19-9 were elevated in 15 cases respectively or simultaneously.All patients received surgery.Pancreatoduodenectomy was performed on 2 patients,distal pancreatectomy(DP)combined with splenectomy on 22 patients,spleen-preserving DP on 14 patients,middle pancreatectomy on 1 patient,palliative resection on 1 patient and tumor enucleation on 2 patients.The mean time for surgery was 2.80 hours,and the mean volume of bleeding during operation was 277.14 ml.Pancreatic fistula was the major complication after operation occuring in 6 cases(14.29%).40 patients were followed up for 3-72 months,with a median follow-up of 43.3 months.3 cases were dead while the others were with a good prognosis.The result showed significant difference in tumor size between the invasive MCN and noninvasive MCN [(8.46±3.30)cm vs.(5.17±2.07)cm,P=0.008].The difference in operative time and hospital stay between the two groups was significantly.Presence of a solid component or mural nodule,serum CEA,serum CA19-9 and tumor size were significantly different between the two groups.On univariate binary logistic regression,presence of a solid component or mural nodule,serum CEA,serum CA19-9 and tumor size were associated with the risk of invasive MCN.When accounting for these factors in multivariable analysis,presence of a solid component or mural nodule [OR=18.750,95% CI: 2.142-436.736,P=0.012] and tumor size [OR=31.569,95% CI: 1.274-782.438,P=0.035] were independent preoperative risk factors for invasive MCN.Conclusions:MCN were located predominantly in the body and tail of the pancreas and primarily affected middle aged women.Radiological examination,CT scan in particular,can be used for predicting the possibility of invasive MCN.The tumor size of invasive MCN was larger than noninvasive MCN.Presence of a solid component or mural nodule,serum CEA,serum CA19-9 and tumor size were associated with the risk of invasive MCN,while presence of a solid component or mural nodule and tumor size were independent preoperative risk factors.The time for surgery and postoperative hospital stay of noninvasive MCN was shorter than invasive MCN.