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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)., Conclusion: 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., (© 2016 S. Karger AG, Basel.)

Despite the increasing number of clinical trials in pancreatic cancer there are no widely accepted definitions of different types of resection for pancreatic cancer. An agreed definition of the standard Kausch-Whipple pancreatoduodenectomy was derived by a group of international experts at a meeting in Castelfranco Veneto, Italy, in May 1998. The lymph node groups to be removed en bloc with the pancreatoduodenectomy and described using the Japanese Pancreas Society classification were as follows: 13a and 13b; 17a and 17b; 12b1, 12b2 and 12c; and 14a and 14b. Limited segmental major venous resection and adjacent organ resection, if required, may be included as part of a standard pancreatoduodenectomy. The pylorus-preserving procedure also may be included as part of standard resection, but not for tumours of the anterior-superior part of the head of the pancreas. Wider adoption of the definition of standard Kausch-Whipple resection will enable a more objective comparative analysis of the radicality of resection between institutions and permit a more coherant analysis on the type of surgery undertaken in multicentre adjuvant studies.