Cystic tumors of the pancreas: diagnostics and surgical treatment

Abstract

Background. The variety of cystic tumors of the pancreas from benign to malignant, the availability of a large number of modern diagnostic methods, increasingly directs surgeons to systematize already existing experience and to search for new algorithms for the treatment of patients from the standpoint of evidence-based medicine. The purpose of the work is to analyze literary sources related to the results of diagnosis and surgical interventions for patients with various forms of cystic tumors of the pancreas, with the aim of determining the strategy of their surgical treatment. Materials and Methods. The data of full-text publications obtained as a result of a literature search in the Scopus and PubMed databases for the period from 2009 to 2022, which were devoted to the issues of surgical treatment of various morphological forms of cystic tumors of the pancreas, were analyzed and systematized. The search was conducted using the following keywords: «cystic tumor», «mucinous cystadenoma», «cystadenocarcinoma», «pseudocyst of the pancreas», «diagnostics», «surgical treatment». Results. For the diagnosis of cystic tumors of the pancreas, the entire range of known methods of perioperative research is used. The extent of surgical intervention for benign cysts is determined by such factors as the size of the neoplasm, its relationship with the parenchyma of the pancreas, the main pancreatic duct, and the vessels of the organ. Mucinous cystic tumors are an indication for surgical treatment. If the size of the serous cystadenoma is less than 3–4 cm, surgical intervention can be postponed, such patients are subject to dynamic observation. The choice of method of resection of the pancreas depends on the location of the tumor and may include distal pancreatectomy with or without splenectomy, median pancreatectomy, or Whipple pancreatoduodenal resection. When the neoplasm is located proximally, classical pancreatoduodenal resection is performed, and its localization in the body or tail of the gland requires distal resection of the organ. Laparoscopic technology can be an alternative for such damage to the gland by a small or medium-sized tumor. Issues of lymph node dissection and adjuvant chemotherapy currently remain debatable. Conclusions. Thus, the analysis of foreign literature on diagnosis and surgical treatment of cystic tumors of the pancreas showed that the use of modern instrumental examination methods affects the results of treatment of patients with this pathology. Fine-needle aspiration of cyst fluid is a safe, highly accurate diagnostic manipulation when cytological diagnosis of a cystic lesion of the pancreas is required. Multispiral computed tomography with bolus contrast enhancement remains the «gold standard», but the use of magnetic resonance imaging, endoscopic ultrasonography, and positron emission tomography are increasingly used to assess the operability, staging, and resect ability of cystic tumors. Knowledge and interpretation of imaging data are crucial for developing personalized patient treatment algorithms and improving treatment outcomes and patient quality of life.