Serous cystic neoplasm of the pancreas: a multinational study of 2622 patients under the auspices of the International Association of Pancreatology and European Pancreatic Club (European Study Group on Cystic Tumors of the Pancreas).

OBJECTIVES: Serous cystic neoplasm (SCN) is a cystic neoplasm of the pancreas whose natural history is poorly known. The purpose of the study was to attempt to describe the natural history of SCN, including the specific mortality. DESIGN: Retrospective multinational study including SCN diagnosed between 1990 and 2014. RESULTS: 2622 patients were included. Seventy-four per cent were women, and median age at diagnosis was 58 years (16-99). Patients presented with non-specific abdominal pain (27%), pancreaticobiliary symptoms (9%), diabetes mellitus (5%), other symptoms (4%) and/or were asymptomatic (61%). Fifty-two per cent of patients were operated on during the first year after diagnosis (median size: 40 mm (2-200)), 9% had resection beyond 1 year of follow-up (3 years (1-20), size at diagnosis: 25 mm (4-140)) and 39% had no surgery (3.6 years (1-23), 25.5 mm (1-200)). Surgical indications were (not exclusive) uncertain diagnosis (60%), symptoms (23%), size increase (12%), large size (6%) and adjacent organ compression (5%). In patients followed beyond 1 year (n=1271), size increased in 37% (growth rate: 4 mm/year), was stable in 57% and decreased in 6%. Three serous cystadenocarcinomas were recorded. Postoperative mortality was 0.6% (n=10), and SCN's related mortality was 0.1% (n=1). CONCLUSIONS: After a 3-year follow-up, clinical relevant symptoms occurred in a very small proportion of patients and size slowly increased in less than half. Surgical treatment should be proposed only for diagnosis remaining uncertain after complete workup, significant and related symptoms or exceptionally when exists concern with malignancy. This study supports an initial conservative management in the majority of patients with SCN. TRIAL REGISTRATION NUMBER: IRB 00006477.

[BILIARY HYPERTENSION IN CHRONIC PANCREATITIS AND PECULIARITIES OF ITS DIAGNOSIS].

Possibilities of various diagnostic methods for biliary hypertension detection in chronic pancreatitis were analyzed. Biliary hypertension was revealed in 163 (31%) patients, suffering chronic pancreatitis. The laboratory investigations data, ultrasonographic investigation, computer tomography, endoscopic retrograde cholangiopancreatography, magnet-resonance cholangiopancreatography, intraoperative measurement of the biliary ducts width, intraoperative measurement of biliary pressure were applied for diagnosis. Endoscopic retrograde cholangiopancreatography, magnet-resonance cholangiopancreatography and intraoperative measurement of biliary pressure are considered the most sensitive methods for chronic pancreatitis diagnosis.

[SURGICAL TREATMENT OF TUMORS OF THE LEFT PANCREATIC ANATOMICAL SEGMENT].

The results of treatment of 231 patients, suffering tumoral affection of pancreatic left anatomical segment in period of 2009-2013 yrs were analyzed. Individualized approach, using modern technologies, was applied. Radical operations were performed in 129 patients, ageing 14-81 yrs old, including pancreatic distal resections in various modifications, central resection and tumoral enucleation. Possibilities of the extended pancreatic resection performance were studied in conditions of tumoral invasion of adjacent organs, regional vessels, as well as impact of such interventions on postoperative complications and lethality rate. While performing pancreatic subtotal distal resection with simultant resection of affected main venous vessels and adjacent organs the operative intervention risk is enhanced, but possibilities of a radical operations performance in previously considered inoperable patients are expanding.

[Modern insights into the problem of surgical treatment of chronic pancreatitis].

Results of surgical treatment of 290 patients, suffering chronic pancreatitis, were ana- lyzed. Frey's operation was performed in 125 patients, and in 11 - the biliodigestive anastomoses formation was added for biliary hypertension. Pancreaticoduodenal resection was performed in 8 patients, the Bern's modification of Beger's operation and distal pancreatic resection - in 6 for each, longitudinal pancreaticojejunostomy - in 69. In 46 patients, suffering ripe pancreatic pseudocysts, a cystojejunostomy and cystopancreatojejunostomy were performed, in 6 - endoscopic cystogastrostomy and cystoduodenostomy, in 7 - external drainage of the cyst. In 17 patients, suffering duodenal or the biliary system impassability, a bypass anastomoses were formatted.

[Pancreatic resection using laparoscopic access].

Experience of their own on performance of pancreatic resection interventions, using laparoscopic access, conducted in the clinic in 2009 - 2013 yrs, was presented. In 8 patients laparoscopic distal pancreatic resection was conducted, in 5--laparoscopic enucleation of pancreatic tumor, in 1--laparoscopic pancreaticoduodenal resection. The results were compared with such after open operations, performed in this period of time. There was not a trustworthy difference in the postoperative complications rate, intraoperative blood loss severity and the distal resection duration. The patient stationary treatment duration was trustworthy less after conduction of laparoscopic operations. The intraoperative blood loss severity and duration of laparoscopic enucleation of pancreatic tumor are trustworthy less.

[Diagnosis and treatment tactics for complicated pancreatic pseudocysts].

Experience of 84 patients treatment for complicated pancreatic gland pseudocysts is presented. Tactics of diagnosis and treatment for complicated pancreatic gland pseudocysts was elaborated and substantiated. Individualized treatment-diagnosis approach provides, first of all, the complications elimination, an adequate surgical treatment of pancreatic gland pseudocyst is possible in late period. For complicated pancreatic pseudocysts treatment miniinvasive methods were used predominantly, when their application is impossible or fails the open procedure is performed.

[Application of preparations--analogues of somatostatin in surgical pancreatology].

The experience of application of shortly acting and durably acting preparations--analogues of somatostatin in complex therapy of various pancreatic diseases was summarized. There was established similar efficacy of the preparations in blockade of the pancreatic external secretion and the various duration of their inhibiting influence on the blood flow. The trustworthy differences in the complications frequency and lethality while application of various preparations--analogues of somatostatin were not revealed.