title: Management and Outcome of 64 Patients with Pancreatic Serous Cystic Neoplasms.
abstract: BACKGROUND
  The optimal management approach to pancreatic serous cystic neoplasms (SCNs) is still evolving.
  
  
  METHODS
  Consecutive patients with SCN managed at the Liverpool Pancreas Cancer Centre between 2000 and 2013 were retrospectively reviewed.
  
  
  RESULTS
  There were 64 patients consisting of 39 women (60.9%) and 25 men (39.1%). Forty-seven patients (73.4%) had surgical removal and 17 (26.6%) were observed. The possibility of a non-SCN malignancy was the predominant indication for resection in 27 (57.4%) patients. Postoperative morbidity occurred in 26 (55.3%) patients with 2 (4.3%) deaths. An increased risk of resection was associated with patient's age (p = 0.011), diagnosis before 2009 (p < 0.001), pain (p = 0.043), possibility of cancer (p = 0.009) and a solid SCN component on imaging (p = 0.002). Independent factors associated with resection were a diagnosis before 2009 (p = 0.005) and a solid SCN component (p < 0.001). Independent factors associated with shorter time to surgical resection were persistent pain (p = 0.003) and a solid SCN component (p = 0.007).
  
  
  CONCLUSIONS
  There was a reduction in the proportion of resections with the application of an observe-only policy for asymptomatic patients with more definite features of SCN. Improved criteria are still required in the remainder of patients with uncertain features of SCN in deciding for intervention or surveillance.
authors.affiliation: National Institutes of Health Research Liverpool Pancreas Biomedical Research Unit and Clinical Directorate of General Surgery, University of Liverpool, Liverpool, UK.
authors.forename: Ilias P
authors.initials: IP
authors.lastname: Gomatos
authors.forename: Christopher
authors.initials: C
authors.lastname: Halloran
authors.forename: Paula
authors.initials: P
authors.lastname: Ghaneh
authors.forename: Michael
authors.initials: M
authors.lastname: Raraty
authors.forename: Fotis
authors.initials: F
authors.lastname: Polydoros
authors.forename: Fiona
authors.initials: F
authors.lastname: Campbell
authors.forename: Jonathan
authors.initials: J
authors.lastname: Evans
authors.forename: Robert
authors.initials: R
authors.lastname: Sutton
authors.forename: Jo
authors.initials: J
authors.lastname: Garry
authors.forename: Philip
authors.initials: P
authors.lastname: Whelan
authors.forename: John P
authors.initials: JP
authors.lastname: Neoptolemos
mesh_terms: D015746:Abdominal Pain / Q000209:etiology / Q000601:surgery; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018297:Neoplasms, Cystic, Mucinous, and Serous / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D010180:Pancreatectomy / Q000009:adverse effects; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D057832:Watchful Waiting