23. Pancreatic Serous Cystadenoma: Tumor Growth Rates and Recommendations For Treatment
Jennifer F. Tseng, MD*, Andrew L. Warshaw, MD, Dushyant V. Sahani, MD*, Gregory Y. Lauwers, MD*, David W. Rattner, MD, Carlos Fernandez-del Castillo, MD*
Massachusetts General Hospital, Boston, MA

OBJECTIVE(S):
To define the natural history and optimal treatment of pancreatic serous cystadenoma.
METHODS:
Records of 106 patients with pancreatic serous cystadenoma (1976-2004) were evaluated for patient and tumor characteristics, diagnostic workup, treatment, and outcomes. Patients with serial imaging were identified and tumor growth curves were calculated.
RESULTS:
Mean age was 61.5 years; women (n=80) were significantly younger (60 vs.67, p=0.018). Symptoms included abdominal pain (24%), fullness/mass (10%), jaundice (7%), and fatigue/malaise (6%). 40% were asymptomatic. Symptomatic and asymptomatic patients did not differ in age. Mean tumor diameter was 4.5+3.1 cm, which did not vary by location. Tumors <4cm were less symptomatic than tumors >4cm (22% vs.78%,p<0.001). Serial radiography was analyzed for 24 patients. The median growth rate was 0.60 cm/yr. For tumors <4cm at presentation (n=15), the rate was 0.12 cm/yr; for tumors >4cm (n=9), the rate was 1.98 cm/yr (p=0.0002;see figure). 80 patients underwent operation. No cystadenocarcinomas were identified. One perioperative death occurred from pulmonary embolism.
CONCLUSIONS:
We report the largest experience and first serial growth measurements of pancreatic serous cystadenomas. Currently, nearly half are incidentally discovered. Tumors <4cm at presentation grow at a rate of 0.12 cm/yr, but tumors >4cm grow at nearly 2 cm/yr. We therefore recommend that patients with serous cystadenomas >4cm and reasonable life expectancies undergo resection, whereas patients with smaller asymptomatic lesions may be treated nonoperatively, with serial imaging.

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