Serous cyst adenoma of the pancreas: Appraisal of active surgical strategy before it causes problems

Background Patients who are diagnosed with symptomatic or ambiguous serous cyst adenoma (SCA) need surgery. The purpose of this study is to suggest a potential management plan based on analysis of surgically treated SCAs. Methods Between August 1995 and December 2010, 38 patients with SCA were surgically treated. Data were analyzed retrospectively. Results Among 38 patients, 28 were female and ten were male. Mean age was 49.6 ± 14.1 years, and five patients (13.2%) were older than 65 years. Among the five patients, two were more than 70 years old. Seventeen patients (44.7%) were symptomatic, and the rest (21, 55.3%) were incidentally found to have SCA. Twenty-seven patients underwent open pancreatectomy, and 11 patients received laparoscopic distal pancreatectomy. Mean tumor size was 4.4 ± 2.8 cm. Most asymptomatic patients of SCA had a left-sided pancreatic tumor and distal pancreatectomy with or without splenectomy were frequently performed with short operative time and less blood transfusion (P\0.05). Minimally invasive surgery was mostly applied to leftsided tumors less than 5 cm in size (11/19 vs. 0/6, P = 0.029). Combined resection of the right colon was performed in two patients (5.3%) due to severe adhesion associated with large tumors. Significant association was noted between age and tumor size in asymptomatic patients (correlation coefficient = 0.541, R² = 0.293, P = 0.014). Postoperative pancreatic fistula was observed in five patients (13.2%, grade B) but could be managed conservatively. No mortality was found. Conclusion Before SCA causes symptoms or grows larger than 5 cm, an active surgical approach, such as minimally invasive surgery, needs to be considered.