Peer reviewer: Christopher Christophi, Professor and Head of the University of Melbourne Department of Surgery, Austin Hospital, Melbourne, 145 Studley Road, Victoria 3084, Australia
S- Editor Wang YR L- Editor O'Neill M E- Editor Lin YP
The purpose of this study was to investigate the actual management of mucinous cystic neoplasm (MCN) of the pancreas. A systematic review was performed in December 2009 by consulting PubMed MEDLINE for publications and matching the key words “pancreatic mucinous cystic neoplasm”, “pancreatic mucinous cystic tumour”, “pancreatic mucinous cystic mass”, “pancreatic cyst”, and “pancreatic cystic neoplasm” to identify English language articles describing the diagnosis and treatment of the mucinous cystic neoplasm of the pancreas. In total, 16 322 references ranging from January 1969 to December 2009 were analysed and 77 articles were identified. No articles published before 1996 were selected because MCNs were not previously considered to be a completely autonomous disease. Definition, epidemiology, anatomopathological findings, clinical presentation, preoperative evaluation, treatment and prognosis were reviewed. MCNs are pancreatic mucin-producing cysts with a distinctive ovarian-type stroma localized in the body-tail of the gland and occurring in middle-aged females. The majority of MCNs are slow growing and asymptomatic. The prevalence of invasive carcinoma varies between 6% and 55%. Preoperative diagnosis depends on a combination of clinical features, tumor markers, computed tomography (CT), magnetic resonance imaging, endoscopic ultrasound with cyst fluid analysis, and positron emission tomography-CT. Surgery is indicated for all MCNs.
Becourt first described cystic lesions of the pancreas in 1824. In 1978, Compagno et al first classified cystic tumors into serous cystic neoplasms (SCNs) and mucinous cystic neoplasms (MCNs) of the pancreas and identified MCN as a distinct disease occurring almost exclusively in the pancreas body and tail of middle-aged women[2,3]. Until 1996, when the World Health Organization distinguished between intraductal papillary mucinous neoplasms (IPMNs) and MCNs, emphasizing the presence of ovarian stroma in the latter, and until 1997 when the Armed Forces Institute of Pathology confirmed this distinction, MCN and IPMNs were frequently confused[3-7]. Nowadays, they represent two distinct neoplasms with different biologic behaviour, pathologic features, and prognosis[8-11].
Although until 1987, Warshaw et al considered that pseudocysts account for the majority of pancreatic cystic lesions, nowadays mucinous and serous cystic tumors represent 50%-60% of all cystic lesions. Nevertheless pancreatic cystic neoplasms occur with less frequency than solid ones[4,14,15], but are now found with increasing frequency compared to the past due to the improvement and refining of modern imaging techniques like multidetector, three-dimensional computed tomography (CT) or magnetic resonance imaging (MRI), or endoscopic ultrasound (EUS).
The aim of this study was to review the literature to clarify the management of cystic mucinous neoplasm of the pancreas.
A comprehensive literature review was performed in December 2009 by consulting PubMed MEDLINE for publications, matching the key words of “pancreatic mucinous cystic neoplasm”, “pancreatic mucinous cystic tumor”, “pancreatic mucinous cystic mass”, “pancreatic cyst” and “pancreatic cystic neoplasm” to identify English language articles on MCNs.
Only studies including series with more than four patients affected by MCNs were included. Articles reporting reviews, case reports, abstracts and studies on only IPMNs, SCNs or pancreatic pseudocysts were excluded. Definition, epidemiology, anatomopathological findings, clinical presentation, preoperative evaluation, treatment and prognosis were analyzed.
A total of 16 322 references ranging from January 1969 to December 2009 were analyzed (“pancreatic mucinous cystic neoplasm”, n = 930; “pancreatic mucinous cystic tumor”, n = 924; “pancreatic mucinous cystic mass”, n = 143; “pancreatic cyst”, n = 6215; “pancreatic cystic neoplasm”, n = 8110) and 77 articles were selected[10,14,17-89]. No articles before 1996 were usable because MCNs were not previously considered as a completely autonomous disease[9-11,17,77,86,89,90].
MCNs are defined as mucin-producing and septated cyst-forming epithelial neoplasia of the pancreas with a distinctive ovarian-type stroma. Usually solitary, their size ranges between 5 and 35 cm with a thick fibrotic wall and without communication with the ductal system. MCNs are rare and, in most series, less common than IPMNs and SCNs. MCNs show a female to male ratio of 20 to 1 and a mean age at diagnosis of between 40 and 50 years (range 14-95 years)[6,7,10,11,91-93]. The site of the neoplasm is in the body and tail of the pancreas in 95%-98% of cases[3,7,9,34,35,89,94,95]. When localized in the pancreatic head, mucinous cystoadenocarcinoma is more prevalent[7,10].
Invasive carcinoma incidence in MCN varies between 6% and 36%[8-11,14,34,35,86]. The Ulm series reported on 39 patients with MCNs and a malignant histology in 51%, including carcinoma in situ and advanced cancer. The explanation of this wide range may be the difficulty in interpreting the data on the prevalence of carcinoma because the majority of series have only indicated the advanced form.
Macroscopically, MCNs usually appear as solitary, multilocular or unilocular lesions with a mean size of 7-8 cm (range 0.5-35 cm) with a thick fibrotic wall and containing mucin, even when hemorrhagic, watery or necrotic content is observed.
In 2004, the consensus conference of the International Association of Pancreatology in Sendai (Japan)[8,9] established that the histological presence of unique ovarian-type stroma was mandatory to diagnose MCN and that this was not found in other pancreatic neoplasms[10,73,93]. MCNs display no communication with the pancreatic ductal system, although some studies suggested that a small proportion of MCNs may show microscopic communication with the pancreatic ducts[68,96,97].
Under light microscopy, the cysts are lined by a columnar mucin-producing epithelium with different grade of dysplasia: mild (MCN adenoma), moderate (MCN borderline), and severe (MCN carcinoma in situ). The epithelial lining is positive for CKs (CK7, CK8, CK18, CK19), EMA and, less frequently, CK20, CEA, DUPAN-2 and CA 19-9[8,10,67]. An invasive adenocarcinoma of the tubular or ductal type is associated in about one-third of cases. The immunophenotype of ovarian-type stroma is similar to the normal ovarian one with positivity for vimentin, calretinin, tyrosine hydroxylase, SMA, α-inhibin, Melan-A, CD99 and Bcl-2 and frequently for PR and ER. The origin of ovarian stroma of the pancreas is still being debated. A stimulation of endodermal immature stroma by female hormones or primary yolk cell implantation in the pancreas has been suggested in literature because buds of the genital tract and dorsal pancreas are adjacent to each other during embryogenesis. Moreover, dorsal pancreatic enlargement mainly gives rise to the pancreatic body and tail, and this could explain the predilection of MCNs for the distal pancreas.
Although the pathologic diagnosis of malignancy is based on invasion of the pancreatic parenchyma or metastases, MCNs that do not have conclusive evidence of carcinoma are considered premalignant.
A thickened wall with peripheral calcification and papillary proliferations, vascular involvement and hypervascular pattern should be considered as suggestive of MCN with malignant changes[68,95]. Although the invasive MCN (mucinouscystoadenocarcinoma or mucinous cystic neoplasm with associated invasive carcinoma) is generally a tubular/ductal carcinoma, rare histological variants are represented by undifferentiated carcinoma with osteoclast-like giant cells, adenosquamous or colloid cells, or sarcomatoid carcinoma, carcinosarcoma and choriocarcinoma[8,102].
The increasing degree of dysplasia and tendency for invasion have been correlated with activating point mutations in the k-ras gene and mutations in the TP5 gene[8,103,104]; moreover, the discovery that the inactivation of SMAD4/DPC4 in the epithelium of the invasive MCNs, but not in the ovarian-like stroma, could suggest that the ovarian-type stroma is not neoplastic.
The majority of MCNs are slow growing and asymptomatic. In a series of 212 consecutive patients with cystic pancreatic lesions, 36.7% were asymptomatic and among them 28% had MCNs; in the symptomatic group, 16% had MCN. In spite of these lesions being occasionally discovered in patients scanned for other indications[16,35,107], the typical clinical appearance is characterized by epigastric heaviness and fullness (60%-90%) or by an abdominal mass (30%-60%)[7,10,12,35,89,106,108]. Nausea, vomiting (20%-30%) and back pain (7%-40%) can also be present.
No specific symptom was significantly associated with a likelihood of malignancy although increasing anorexia and weight loss (10%-40%) may be associated with malignant changes[7,12,35,89,95,106,108,109].
MCNs main differential diagnosis includes other neoplastic cystic lesions (serous cystic neoplasm and the intraductal papillary mucinous neoplasms) and non-neoplastic cystic lesions (pancreatic pseudocysts). There is no single discriminating test, but preoperative diagnosis depends on a combination of modes, including clinical features, tumor markers, CT and MRI, EUS with cyst fluid analysis, and positron emission tomography (PET).
High values of CEA and CA 19-9 show a high positive predictive value for pancreatic malignancy or pre-malignancy in the preoperative assessment of pancreatic cystic mass (70%-100%)[9,95,110]. A CEA level of more than 400 ng/mL is a good predictor of malignancy in MCNs (sensitivity 45%-50%, specificity 95%-100%, accuracy 75%-80%)[107,111,112].
Trans-abdominal ultrasound examination has a low accuracy (50%) for cystic neoplasms of the pancreas.
EUS improves that accuracy and allows better evaluation of the wall as it may show separation or nodules within the cyst. Furthermore, EUS can be used to obtain aspiration of the cyst contents and to perform a biopsy of the wall. Cyst fluid amylase concentration of < 250 U/L has been considered capable of excluding pseudocysts of the pancreas (sensitivity 40%-45%, specificity 95%-100%, accuracy 60%-65%), while CEA < 5 ng/mL could suggest a benign etiology (sensitivity 45%-50%, specificity 95%-100%, accuracy 65%-70%)[31,111]. EUS-FNA cytology and cyst fluid CEA greater than 192 ng/mL show the highest accuracy (79%) for differentiating mucinous cystic from non-mucinous cystic neoplasms. On the contrary EUS morphology alone cannot distinguish between the two groups[47,50,113].
In any case, the main differential diagnosis of MCNs is with SCNs which have a low CEA in the fluid and an equal distribution throughout the pancreas, with pancreatic pseudocysts (PC) that usually show necrotic debris within the cyst cavity, and with branch duct IPMNs communicating with the ductal pancreatic system and consequently showing elevated cystic fluid amylase.
Although pancreatitis may be present in the history of patients with pancreatic cystic neoplasms, when a cyst arises in a patient with chronic pancreatitis, the most frequent diagnosis is PC. On the other hand, when pancreatitis is unexpected and occurs for the first time, the cyst could be a tumor, determining the development of pancreatitis due to compression of the pancreatic duct. This is a crucial problem, because the risk of managing cystic mucinous neoplasms in patients with a prior history of pancreatitis, like pseudocysts by a pseudocyst-jejunal anastomosis or pseudocyst-gastrostomy, is higher than usual, with disastrous long-term prognosis[12,83]. Proper sampling of pseudocysts is essential and should consist of sampling of the cyst wall during surgery or analysis of cyst content during minimal access drainage procedures. Although the clinical context, radiological imaging and biochemical findings may help differentiate PC from cystic neoplasms, small lesions may be problematic.
|Type of lesions||Morphologic features||Pancreatic cystic lesions|
|Unilocular cyst||Without internal septation and solid component or wall calcification||Serous cystic neoplasm, intraductal papillary mucinous neoplasm1, pancreatic pseudocyst|
|Microcystic lesion||Six or more cysts with diameter 0.2 mm-2 cm, external lobulation, fibrous central scar with or without stellate calcifications||Serous cystic neoplasm|
|Macrocystic lesions||Diameter > 2 cm, with internal septation and solid component or wall calcification||Intraductal papillary mucinous neoplasm1, mucinous cystic neoplasm2|
|Cyst with a solid component||Unilocular or multilocular||Intraductal papillary mucinous neoplasm1, mucinous cystic neoplasm2|
The demonstration of a solid component, invasion outside the confines of the pancreas, or pancreatic duct obstruction through EUS is highly indicative of malignancy with sensitivity, specificity and accuracy of 70%, 100% and 60%, respectively. However, in the absence of these findings the ability of EUS to diagnose malignancy is limited with an overall sensitivity, specificity and accuracy of 56%, 45% and 51%, respectively. The added advantage of EUS in performing aspiration of cyst content and sampling of the cyst wall and septa or mural nodules is that it allows small lesions as well as suspicious areas to be analysed. Laparoscopic and intraoperative ultrasounds are highly operator dependent with an accuracy ranging from 40% to 90%[3,114-120].
Multidetector computed tomography and magnetic resonance cholangiopancreaticography (MRCP) play a critical role in assessment, defining size, septation, calcifications, nodules of the wall, and communication with the ductal system of the pancreatic cyst.
At cross-sectional imaging, the MCN appears as a unilocular or multilocular single macrocyst with a solid component, with no communication with the main duct[95,107,121]. The internal architecture of the cyst, including septa and internal wall, is best appreciated with MR imaging[122,123].
Recently, Kim et al defined some significant CT features for differentiating MCNs from SCNs and IPMNs: the shape is smooth in MCNs, multicystic and lobulated in SCNs, and pleomorphic and clubbed finger-like in IPMNs; the main pancreatic duct is not dilated or proximally only in SCNs, and if dilated, whole in IPMN.
In spite of the improvement in pancreatic tumor visualization resulting from CT and MRI, the ability to perform diagnosis of these techniques individually - as well as EUS - remains poor (25%-30%)[6,124,125]. In a multivariate analysis by Visser et al in 2008, the combination of CT and MRI data showed an accuracy ranging from 44% to 83%.
Cross-sectional imaging generally shows peripheral calcification, a thickened wall, papillary proliferations, vascular involvement and hypervascular pattern in the cases of malignant MCNs[36,95,126]. Although peripheral eggshell calcification is not easily detected by CT, this is a specific feature of the MCNs and is highly predictive of malignancy.
The clinical value of MRCP is similar to endoscopic retrograde cholangiopancreatography or percutaneous transhepatic cholangiography but an MR multi-imaging protocol, which includes MR cross-sectional imaging, MRCP and dynamic contrast-enhanced MR angiography, integrates the advantages of multiple imaging techniques without morbidity[128-131].
The role of PET in managing pancreatic cystic lesions is currently limited but recent studies report detection of malignant pancreatic cysts with sensitivity and positive predictive values above 90%[132,133].
Surgical excision is indicated for all MCNs considered pre-malignant. Factors influencing treatment include tumor histological features, the patient’s age and surgical risk, and tumor size and location.
Because mucinous cystic adenoma of the pancreas are usually localized at the level of the body and tail of the pancreas, the most common operation performed to cure these neoplasms is distal pancreatectomy (Figure 1), which is a safe procedure in high volume centres (overall postoperative morbidity ranging from 5% to 50% and a mortality rate of 0%)[3,7,20,35,134,135]. The main complication, pancreatic fistula, occurs in 15%-20% of cases.
The distal pancreatectomy technique was first described in 1913 by Mayo and the spleen-preserving distal pancreatectomy was outlined in 1943 by Mallet-Guy et al. Preservation of the spleen can be performed with or without preservation of the splenic artery and vein. In 1988, Warshaw described a technique without the preservation of the splenic artery and vein, ligating the splenic vessels at the hilum. Although this method appears technically less difficult and can be performed in a shorter operating time, it has been associated with a higher incidence of spleen vascular insufficiency. However, this procedure should be considered in the event of an inflamed or fibrosed splenic artery and vein. Spleen-preserving techniques must be avoided when in the presence of the largest tumors or risk factors for invasive malignancy, such as the size of the lesion, eggshell calcifications and mural nodules, in order to perform the complete oncological lymph node dissection[9,27,31]. However, these techniques are preferred in all other cases to avoid long term infectious and haematological complications[3,20,27,139].
Studies comparing patients undergoing distal pancreatectomy with or without splenectomy show no significant differences compared to perioperative complications, mean operating time, pancreatic fistula rate, length of hospital stay and mortality[20,108,135,141,142].
MCNs affecting the pancreatic neck or the proximal body could be managed either by an extended right or, more frequently, by an extended left pancreatectomy. These extended resections of normal pancreatic tissue may induce endocrine and exocrine insufficiency respectively in 30%-35% and 15%-20%, which in a benign or premalignant disease could be discussable[143-147].
Middle pancreatectomy can be considered in the surgical management of MCNs located at the level of the pancreatic proximal body or neck, preserving endocrine and exocrine function with respect to extended left pancreatectomy or pancreaticoduodenectomy, and also preserving the spleen.
Different techniques have been proposed for gastrointestinal reconstruction, including jejunal anastomosis of the stump or the distal stump, with pancreaticoduodenal or pancreaticogastric anastomosis[143,148-156].
In the literature, mortality after middle pancreatectomy was none and the overall morbidity was 25%-35%[147-149,155-157]. The incidence of overall pancreatic fistula was 22%-45% and the type of reconstruction through Roux-en-Y pancreatojejunostomy or pancreaticogastrostomy did not affect the rate of any complication[147-149,155-157]. Moreover, the incidence of endocrine and exocrine insufficiency after middle pancreatectomy was 4%-7% and 5%-8%, respectively[147-149,155-157].
Because the probability of malignancy in patients with MCNs smaller than 2 cm without nodules is very low, enucleation could be performed to avoid post-operative pancreatic insufficiency. This procedure is proposed for patients with MCNs smaller than 2 cm with benign features and superficially located[146,155,156]. Enucleation can be performed without risk of recurrence but has been associated with a higher incidence of pancreatic fistula (30%-50%)[158-160].
A major oncologic resection, applying a Kausch-Whipple or pylorus-preserving technique, is recommended for MCNs that are localized monocentrically in the head.
The operative mortality ranges from 0% to 5% and is generally related to pancreatic anastomosis complications[136,161]. The most common complications following the Whipple procedure are delayed gastric emptying and the pancreatic fistula occurring in 5%-10% and 6%-20% of operations, respectively[136,161-163].
When an enucleation is impossible or contraindicated, MCNs localized monocentrically in the pancreatic head that do not have an association with an invasive pancreatic cancer could be treated by duodenum-preserving total pancreatic head resection[34,94,164-167].
This procedure shows significant advantages when compared to Traverso-Longmire or Whipple pancreaticoduodenectomy, as regards the postoperative rate of morbidity and mortality, glucose metabolism, hospitalization and costs[11,168].
Pancreatectomy with lymph node dissection is necessary when an invasive carcinoma is suspected. Although the preoperative and intraoperative assessment of the grade of invasiveness is often difficult, whenever any doubt exists typical resection with lymph node dissection must be pursued. There is no evidence in literature of invasive mucinous cystic adenocarcinoma with distant lymph node metastases, so only a loco-regional lymphadenectomy is justified[3,35]. Because the probability of malignancy is very low in the cases of small MCNs without nodules, lymphadenectomy can be avoided[3,146].
In the cases of benign-appearing and small malignant lesions (< 5 cm), a minimally invasive approach may be considered. Recent experiences from high-volume centers demonstrate that the laparoscopic approach for distal pancreatectomy for MCNs of the body and tail of the pancreas is feasible and safe. The complication rate of laparoscopic distal splenopancreatectomy (Lap SDP) ranges between 15% and 20%[30,46,170-173] with a mortality rate of 0%. In spleen-preserving laparoscopic pancreatic (Lap SPDP) resection, the overall morbidity ranges from 25% to 40% with a mortality rate of 0%[30,46,169-173]. The overall reported pancreatic fistula was 5%-8% and 10%-15% after Lap SPDP and Lap SDP, respectively[30,46,170-173]. This laparoscopic approach decreases the hospital stay and minimizes the cosmetic impact of the surgical wound[30,169,174,175].
Recently, some combinations have been reported to be superior to GEM alone[177,179-181]. GEM-oxaliplatin treatment has been proposed to be more effective in terms of clinical progression-free survival.
Discordant results on survival were reported by phase II and III trials combining GEM and inhibitors of epidermal growth factor receptor (cetuximab) and vascular endothelial growth factor (bevacizumab)[182-184].
Other modest but interesting advances have been provided by combinations such as GEM-capecitabine and GEM plus a platinum salt. In spite of this, survival results remain disappointing.
A conservative management with regular follow-up has been proposed in the presence of asymptomatic cystic lesions of the pancreas smaller than 3 cm without mural nodules, because the reported risk of malignancy in these cysts was found to be 3%[11,35,63,186]. The suggested follow-up consisting of cross-sectional imaging and FNA cytology should be performed every 6 mo for a period of 2 years and yearly after that. This should be continued for at least 4 years and then the interval of follow-up can be lengthened after 6 years of no change[31,52,186]. When the cyst enlarges or when symptoms occur (in up to 20% of patients after follow-up), surgery is mandatory. The reported incidence of the subsequent resection due to change of the clinical, radiological and biochemical features of the lesions after initial conservative treatment was 4%-10% and malignancy rate in these cases was 3%[23,63].
After resection, in the absence of invasive carcinoma, prognosis of MCNs is excellent, with an overall survival rate of 100%[5-7,10,35] and patients do not need follow-up, since several studies have shown that the risk of recurrence following resection is 0%[11,18]. Patients with invasive mucinous cystadenocarcinoma, show a 5-year survival rate of 20%-60%, which is much better than that for non-MCN-associated ductal adenocarcinoma[5-8,11,17,35,73,86]. When an anaplastic carcinoma of the pancreas associated with MCN is reported, the prognosis is obviously extremely poor, with a 3-year survival rate lower than 3%[5-8,11,17,35,73,86].
Although the histological distinction between MCNs and IPMNs, through the identification of ovarian stroma initially, is very important in clinical practice, the management of MCNs has not yet been standardized and continues to evolve.
The approach to patients with suspected MCN is based on EUS and cross-sectional imaging in association with FNA cytology, detecting an incidence of correct differentiation between mucinous cystic and non-mucinous cystic neoplasms of 75%.
Because at present we are unable to identify the benign MCNs that will progress into invasive carcinoma, all MCNs should be resected, regardless of size, in patients who are fit candidates for surgery, because surgery is routinely curative in the cases of non-invasive tumor. Moreover, the non-operative management based on periodic CT or MRI requires years of careful follow-up with a high cost of imaging and the enucleation technique carries the risk of non-oncological radicality. In patients with non-invasive MCN after complete anatomic resection, postoperative surveillance is unnecessary.
In order to obtain more benefit by applying adjuvant chemotherapy for the treatment of the advanced MCNs, further research focused on sequential cellular transformation from benign to malign tumor and on new combinations, incorporating the new targeted therapies and identifying potential predictive factors of response, is required to be able to offer effective tailored treatment to these patients.
Peer reviewer: Christopher Christophi, Professor and Head of the University of Melbourne Department of Surgery, Austin Hospital, Melbourne, 145 Studley Road, Victoria 3084, Australia
S- Editor Wang YR L- Editor O'Neill M E- Editor Lin YP
|1.||Becourt PJ. Recherches sur le pancreas: ses functions et ses alterations organiques. Strasbourg: Levrault 1830; . [Cited in This Article: ]|
|2.||Compagno J, Oertel JE. Microcystic adenomas of the pancreas (glycogen-rich cystadenomas): a clinicopathologic study of 34 cases. Am J Clin Pathol. 1978;69:289-298. [Cited in This Article: ]|
|3.||Fernández-del Castillo C. Mucinous cystic neoplasms. J Gastrointest Surg. 2008;12:411-413. [Cited in This Article: ]|
|4.||Warshaw AL, Compton CC, Lewandrowski K, Cardenosa G, Mueller PR. Cystic tumors of the pancreas. New clinical, radiologic, and pathologic observations in 67 patients. Ann Surg. 1990;212:432-443; discussion 444-445. [Cited in This Article: ]|
|5.||Wilentz RE, Albores-Saavedra J, Zahurak M, Talamini MA, Yeo CJ, Cameron JL, Hruban RH. Pathologic examination accurately predicts prognosis in mucinous cystic neoplasms of the pancreas. Am J Surg Pathol. 1999;23:1320-1327. [Cited in This Article: ]|
|6.||Le Borgne J, de Calan L, Partensky C. Cystadenomas and cystadenocarcinomas of the pancreas: a multiinstitutional retrospective study of 398 cases. French Surgical Association. Ann Surg. 1999;230:152-161. [Cited in This Article: ]|
|7.||Sarr MG, Carpenter HA, Prabhakar LP, Orchard TF, Hughes S, van Heerden JA, DiMagno EP. Clinical and pathologic correlation of 84 mucinous cystic neoplasms of the pancreas: can one reliably differentiate benign from malignant (or premalignant) neoplasms? Ann Surg. 2000;231:205-212. [Cited in This Article: ]|
|8.||Campbell F, Azadeh B. Cystic neoplasms of the exocrine pancreas. Histopathology. 2008;52:539-551. [Cited in This Article: ]|
|9.||Tanaka M, Chari S, Adsay V, Fernandez-del Castillo C, Falconi M, Shimizu M, Yamaguchi K, Yamao K, Matsuno S. International consensus guidelines for management of intraductal papillary mucinous neoplasms and mucinous cystic neoplasms of the pancreas. Pancreatology. 2006;6:17-32. [Cited in This Article: ]|
|10.||Zamboni G, Scarpa A, Bogina G, Iacono C, Bassi C, Talamini G, Sessa F, Capella C, Solcia E, Rickaert F. Mucinous cystic tumors of the pancreas: clinicopathological features, prognosis, and relationship to other mucinous cystic tumors. Am J Surg Pathol. 1999;23:410-422. [Cited in This Article: ]|
|11.||Reddy RP, Smyrk TC, Zapiach M, Levy MJ, Pearson RK, Clain JE, Farnell MB, Sarr MG, Chari ST. Pancreatic mucinous cystic neoplasm defined by ovarian stroma: demographics, clinical features, and prevalence of cancer. Clin Gastroenterol Hepatol. 2004;2:1026-1031. [Cited in This Article: ]|
|12.||Warshaw AL, Rutledge PL. Cystic tumors mistaken for pancreatic pseudocysts. Ann Surg. 1987;205:393-398. [Cited in This Article: ]|
|13.||Simeone DM. SSAT/AGA/ASGE state of the art conference on cystic neoplasms of the pancreas. J Gastrointest Surg. 2008;12:1475-1477. [Cited in This Article: ]|
|14.||Visser BC, Muthusamy VR, Yeh BM, Coakley FV, Way LW. Diagnostic evaluation of cystic pancreatic lesions. HPB (Oxford). 2008;10:63-69. [Cited in This Article: ]|
|15.||Kawarada Y, Yano T, Yamamoto T, Yokoi H, Imai T, Ogura Y, Mizumoto R. Intraductal mucin-producing tumors of the pancreas. Am J Gastroenterol. 1992;87:634-638. [Cited in This Article: ]|
|16.||Salvia R, Crippa S, Falconi M, Bassi C, Guarise A, Scarpa A, Pederzoli P. Branch-duct intraductal papillary mucinous neoplasms of the pancreas: to operate or not to operate? Gut. 2007;56:1086-1090. [Cited in This Article: ]|
|17.||Longnecker DS, Adler G, Hruban RH, Klöppel G. Intraductal papillary-mucinous neoplasms of the pancreas. Pathology and Genetics of Tumours of the Digestive System. WHO Classification of Tumours. Lyon: IARC Press 2000; 237-240. [Cited in This Article: ]|
|18.||Garcea G, Gouda M, Hebbes C, Ong SL, Neal CP, Dennison AR, Berry DP. Predictors of severity and survival in acute pancreatitis: validation of the efficacy of early warning scores. Pancreas. 2008;37:e54-e61. [Cited in This Article: ]|
|19.||Silverman JF, Zhu B, Liu Y, Lin X. Distinctive immunohistochemical profile of mucinous cystic neoplasms of pancreas, ovary and lung. Histol Histopathol. 2009;24:77-82. [Cited in This Article: ]|
|20.||Lee SY, Goh BK, Tan YM, Chung YF, Cheow PC, Chow PK, Wong WK, Ooi LL. Spleen-preserving distal pancreatectomy. Singapore Med J. 2008;49:883-885. [Cited in This Article: ]|
|21.||Xiao GQ. Fine-needle aspiration of cystic pancreatic mucinous tumor: oncotic cell as an aiding diagnostic feature in paucicellular specimens. Diagn Cytopathol. 2009;37:111-116. [Cited in This Article: ]|
|22.||Oh HC, Seo DW, Kim SC, Yu E, Kim K, Moon SH, Park do H, Lee SS, Lee SK, Kim MH. Septated cystic tumors of the pancreas: is it possible to treat them by endoscopic ultrasonography-guided intervention? Scand J Gastroenterol. 2009;44:242-247. [Cited in This Article: ]|
|23.||Walsh RM, Vogt DP, Henderson JM, Hirose K, Mason T, Bencsath K, Hammel J, Brown N. Management of suspected pancreatic cystic neoplasms based on cyst size. Surgery. 2008;144:677-684; discussion 684-685. [Cited in This Article: ]|
|24.||Chaudhari VV, Raman SS, Vuong NL, Zimmerman P, Farrell J, Reber H, Sayre J, Lu DS. Pancreatic cystic lesions: discrimination accuracy based on clinical data and high-resolution computed tomographic features. J Comput Assist Tomogr. 2008;32:757-763. [Cited in This Article: ]|
|25.||Ishikawa T, Takeda K, Itoh M, Imaizumi T, Oguri K, Takahashi H, Kasuga H, Toriyama T, Matsuo S, Hirooka Y. Prevalence of pancreatic cystic lesions including intraductal papillary mucinous neoplasms in patients with end-stage renal disease on hemodialysis. Pancreas. 2009;38:175-179. [Cited in This Article: ]|
|26.||Yoon WJ, Lee JK, Lee KH, Ryu JK, Kim YT, Yoon YB. Cystic neoplasms of the exocrine pancreas: an update of a nationwide survey in Korea. Pancreas. 2008;37:254-258. [Cited in This Article: ]|
|27.||Maker AV, Lee LS, Raut CP, Clancy TE, Swanson RS. Cytology from pancreatic cysts has marginal utility in surgical decision-making. Ann Surg Oncol. 2008;15:3187-3192. [Cited in This Article: ]|
|28.||Kardel E, Gołabek K, Kostro JZ, Sledziński Z. Mucinous cystadenocarcinomas of the pancreas. Hepatogastroenterology. 2008;55:692-694. [Cited in This Article: ]|
|29.||Das A, Wells CD, Nguyen CC. Incidental cystic neoplasms of pancreas: what is the optimal interval of imaging surveillance? Am J Gastroenterol. 2008;103:1657-1662. [Cited in This Article: ]|
|30.||Laxa BU, Carbonell AM 2nd, Cobb WS, Rosen MJ, Hardacre JM, Mekeel KL, Harold KL. Laparoscopic and hand-assisted distal pancreatectomy. Am Surg. 2008;74:481-486; discussion 486-487. [Cited in This Article: ]|
|31.||Edirimanne S, Connor SJ. Incidental pancreatic cystic lesions. World J Surg. 2008;32:2028-2037. [Cited in This Article: ]|
|32.||King J, Kazanjian K, Matsumoto J, Reber HA, Yeh MW, Hines OJ, Eibl G. Distal pancreatectomy: incidence of postoperative diabetes. J Gastrointest Surg. 2008;12:1548-1553. [Cited in This Article: ]|
|33.||Kim SH, Lim JH, Lee WJ, Lim HK. Macrocystic pancreatic lesions: differentiation of benign from premalignant and malignant cysts by CT. Eur J Radiol. 2009;71:122-128. [Cited in This Article: ]|
|34.||Beger HG, Rau BM, Gansauge F, Schwarz M, Siech M, Poch B. Duodenum-preserving total pancreatic head resection for cystic neoplasm: a limited but cancer-preventive procedure. Langenbecks Arch Surg. 2008;393:589-598. [Cited in This Article: ]|
|35.||Crippa S, Salvia R, Warshaw AL, Domínguez I, Bassi C, Falconi M, Thayer SP, Zamboni G, Lauwers GY, Mino-Kenudson M. Mucinous cystic neoplasm of the pancreas is not an aggressive entity: lessons from 163 resected patients. Ann Surg. 2008;247:571-579. [Cited in This Article: ]|
|36.||Goh BK, Tan YM, Cheow PC, Chung YF, Chow PK, Wong WK, Ooi LL. Outcome of distal pancreatectomy for pancreatic adenocarcinoma. Dig Surg. 2008;25:32-38. [Cited in This Article: ]|
|37.||Adham M, Giunippero A, Hervieu V, Courbière M, Partensky C. Central pancreatectomy: single-center experience of 50 cases. Arch Surg. 2008;143:175-180; discussion 180-181. [Cited in This Article: ]|
|38.||Lam MM, Swanson PE, Upton MP, Yeh MM. Ovarian-type stroma in hepatobiliary cystadenomas and pancreatic mucinous cystic neoplasms: an immunohistochemical study. Am J Clin Pathol. 2008;129:211-218. [Cited in This Article: ]|
|39.||Suzuki Y, Sugiyama M, Abe N, Fujioka Y, Atomi Y. Immunohistochemical similarities between pancreatic mucinous cystic tumor and ovarian mucinous cystic tumor. Pancreas. 2008;36:e40-e46. [Cited in This Article: ]|
|40.||Stelow EB, Shami VM, Abbott TE, Kahaleh M, Adams RB, Bauer TW, Debol SM, Abraham JM, Mallery S, Policarpio-Nicolas ML. The use of fine needle aspiration cytology for the distinction of pancreatic mucinous neoplasia. Am J Clin Pathol. 2008;129:67-74. [Cited in This Article: ]|
|41.||Lee CJ, Scheiman J, Anderson MA, Hines OJ, Reber HA, Farrell J, Kochman ML, Foley PJ, Drebin J, Oh YS. Risk of malignancy in resected cystic tumors of the pancreas < or =3 cm in size: is it safe to observe asymptomatic patients? A multi-institutional report. J Gastrointest Surg. 2008;12:234-242. [Cited in This Article: ]|
|42.||Tien YW, Hu RH, Hung JS, Wang HP, Lee PH. Noninvasive pancreatic cystic neoplasms can be safely and effectively treated by limited pancreatectomy. Ann Surg Oncol. 2008;15:193-198. [Cited in This Article: ]|
|43.||Chaudhari VV, Raman SS, Vuong NL, Zimmerman P, Farrell J, Reber H, Sayre J, Lu DS. Pancreatic cystic lesions: discrimination accuracy based on clinical data and high resolution CT features. J Comput Assist Tomogr. 2007;31:860-867. [Cited in This Article: ]|
|44.||Müller MW, Friess H, Kleeff J, Dahmen R, Wagner M, Hinz U, Breisch-Girbig D, Ceyhan GO, Büchler MW. Is there still a role for total pancreatectomy? Ann Surg. 2007;246:966-974; discussion 974-975. [Cited in This Article: ]|
|45.||Reid-Lombardo KM, Ramos-De la Medina A, Thomsen K, Harmsen WS, Farnell MB. Long-term anastomotic complications after pancreaticoduodenectomy for benign diseases. J Gastrointest Surg. 2007;11:1704-1711. [Cited in This Article: ]|
|46.||Fernández-Cruz L, Cosa R, Blanco L, Levi S, López-Boado MA, Navarro S. Curative laparoscopic resection for pancreatic neoplasms: a critical analysis from a single institution. J Gastrointest Surg. 2007;11:1607-1621; discussion 1621-1622. [Cited in This Article: ]|
|47.||Attasaranya S, Pais S, LeBlanc J, McHenry L, Sherman S, DeWitt JM. Endoscopic ultrasound-guided fine needle aspiration and cyst fluid analysis for pancreatic cysts. JOP. 2007;8:553-563. [Cited in This Article: ]|
|48.||Levy MJ, Clain JE, Clayton A, Halling KC, Kipp BR, Rajan E, Roberts LR, Root RM, Sebo TJ, Topazian MD. Preliminary experience comparing routine cytology results with the composite results of digital image analysis and fluorescence in situ hybridization in patients undergoing EUS-guided FNA. Gastrointest Endosc. 2007;66:483-490. [Cited in This Article: ]|
|49.||Ohike N, Sato M, Hisayuki T, Imataka H, Sato S, Wada Y, Saito K, Takahashi M, Tajiri T, Kunimura T. Immunohistochemical analysis of nestin and c-kit and their significance in pancreatic tumors. Pathol Int. 2007;57:589-593. [Cited in This Article: ]|
|50.||Aljebreen AM, Romagnuolo J, Perini R, Sutherland F. Utility of endoscopic ultrasound, cytology and fluid carcinoembryonic antigen and CA 19-9 levels in pancreatic cystic lesions. World J Gastroenterol. 2007;13:3962-3966. [Cited in This Article: ]|
|51.||Teh SH, Tseng D, Sheppard BC. Laparoscopic and open distal pancreatic resection for benign pancreatic disease. J Gastrointest Surg. 2007;11:1120-1125. [Cited in This Article: ]|
|52.||Lahav M, Maor Y, Avidan B, Novis B, Bar-Meir S. Nonsurgical management of asymptomatic incidental pancreatic cysts. Clin Gastroenterol Hepatol. 2007;5:813-817. [Cited in This Article: ]|
|53.||Shami VM, Sundaram V, Stelow EB, Conaway M, Moskaluk CA, White GE, Adams RB, Yeaton P, Kahaleh M. The level of carcinoembryonic antigen and the presence of mucin as predictors of cystic pancreatic mucinous neoplasia. Pancreas. 2007;34:466-469. [Cited in This Article: ]|
|54.||Liu MS, Yang PY, Yeh TS. Sonic hedgehog signaling pathway in pancreatic cystic neoplasms and ductal adenocarcinoma. Pancreas. 2007;34:340-346. [Cited in This Article: ]|
|55.||Javle M, Shah P, Yu J, Bhagat V, Litwin A, Iyer R, Gibbs J. Cystic pancreatic tumors (CPT): predictors of malignant behavior. J Surg Oncol. 2007;95:221-228. [Cited in This Article: ]|
|56.||Hardacre JM, McGee MF, Stellato TA, Schulak JA. An aggressive surgical approach is warranted in the management of cystic pancreatic neoplasms. Am J Surg. 2007;193:374-378; discussion 378-379. [Cited in This Article: ]|
|57.||Moparty B, Logroño R, Nealon WH, Waxman I, Raju GS, Pasricha PJ, Bhutani MS. The role of endoscopic ultrasound and endoscopic ultrasound-guided fine-needle aspiration in distinguishing pancreatic cystic lesions. Diagn Cytopathol. 2007;35:18-25. [Cited in This Article: ]|
|58.||Mansour JC, Schwartz L, Pandit-Taskar N, D'Angelica M, Fong Y, Larson SM, Brennan MF, Allen PJ. The utility of F-18 fluorodeoxyglucose whole body PET imaging for determining malignancy in cystic lesions of the pancreas. J Gastrointest Surg. 2006;10:1354-1360. [Cited in This Article: ]|
|59.||Tanaka M, Sawai H, Okada Y, Yamamoto M, Funahashi H, Takeyama H, Manabe T. Clinicopathologic study of intraductal papillary-mucinous tumors and mucinous cystic tumors of the pancreas. Hepatogastroenterology. 2006;53:783-787. [Cited in This Article: ]|
|60.||Kim SY, Lee JM, Kim SH, Shin KS, Kim YJ, An SK, Han CJ, Han JK, Choi BI. Macrocystic neoplasms of the pancreas: CT differentiation of serous oligocystic adenoma from mucinous cystadenoma and intraductal papillary mucinous tumor. AJR Am J Roentgenol. 2006;187:1192-1198. [Cited in This Article: ]|
|61.||Linder JD, Geenen JE, Catalano MF. Cyst fluid analysis obtained by EUS-guided FNA in the evaluation of discrete cystic neoplasms of the pancreas: a prospective single-center experience. Gastrointest Endosc. 2006;64:697-702. [Cited in This Article: ]|
|62.||Zhai J, Sarkar R, Ylagan L. Pancreatic mucinous lesions: a retrospective analysis with cytohistological correlation. Diagn Cytopathol. 2006;34:724-730. [Cited in This Article: ]|
|63.||Allen PJ, D'Angelica M, Gonen M, Jaques DP, Coit DG, Jarnagin WR, DeMatteo R, Fong Y, Blumgart LH, Brennan MF. A selective approach to the resection of cystic lesions of the pancreas: results from 539 consecutive patients. Ann Surg. 2006;244:572-582. [Cited in This Article: ]|
|64.||Tada M, Kawabe T, Arizumi M, Togawa O, Matsubara S, Yamamoto N, Nakai Y, Sasahira N, Hirano K, Tsujino T. Pancreatic cancer in patients with pancreatic cystic lesions: a prospective study in 197 patients. Clin Gastroenterol Hepatol. 2006;4:1265-1270. [Cited in This Article: ]|
|65.||Carboni F, Lepiane P, Santoro R, Lorusso R, Mancini R, Proposito D, Spoletini D, Santoro E. Cystic pancreatic neoplasms: 12-year surgical experience. J Exp Clin Cancer Res. 2006;25:167-175. [Cited in This Article: ]|
|66.||Choi EK, Park SH, Kim DY, Kim KW, Byun JH, Lee MG, Ha HK. Unusual manifestations of primary pancreatic neoplasia: Radiologic-pathologic correlation. J Comput Assist Tomogr. 2006;30:610-617. [Cited in This Article: ]|
|67.||Erdogan D, Lamers WH, Offerhaus GJ, Busch OR, Gouma DJ, van Gulik TM. Cystadenomas with ovarian stroma in liver and pancreas: an evolving concept. Dig Surg. 2006;23:186-191. [Cited in This Article: ]|
|68.||Goh BK, Tan YM, Yap WM, Cheow PC, Chow PK, Chung YF, Wong WK, Ooi LL. Pancreatic serous oligocystic adenomas: clinicopathologic features and a comparison with serous microcystic adenomas and mucinous cystic neoplasms. World J Surg. 2006;30:1553-1559. [Cited in This Article: ]|
|69.||Sawai H, Okada Y, Funahashi H, Matsuo Y, Hayakawa T, Tanaka M, Takeyama H, Manabe T. Clinicopathological and immunohistochemical analysis of malignant features in mucinous cystic tumors of the pancreas. Hepatogastroenterology. 2006;53:286-290. [Cited in This Article: ]|
|70.||Lopez Hänninen E, Pech M, Ricke J, Denecke T, Amthauer H, Lehmkuhl L, Böhmig M, Röttgen R, Pinkernelle J, Felix R. Magnetic resonance imaging in the assessment of cystic pancreatic lesions: differentiation of benign and malignant lesion status. Acta Radiol. 2006;47:121-129. [Cited in This Article: ]|
|71.||Shiono S, Suda K, Nobukawa B, Arakawa A, Yamasaki S, Sasahara N, Hosokawa Y, Suzuki F. Pancreatic, hepatic, splenic, and mesenteric mucinous cystic neoplasms (MCN) are lumped together as extra ovarian MCN. Pathol Int. 2006;56:71-77. [Cited in This Article: ]|
|72.||Goh BK, Tan YM, Cheow PC, Chung YF, Chow PK, Wong WK, Ooi LL. Cystic neoplasms of the pancreas with mucin-production. Eur J Surg Oncol. 2005;31:282-287. [Cited in This Article: ]|
|73.||Kosmahl M, Pauser U, Peters K, Sipos B, Lüttges J, Kremer B, Klöppel G. Cystic neoplasms of the pancreas and tumor-like lesions with cystic features: a review of 418 cases and a classification proposal. Virchows Arch. 2004;445:168-178. [Cited in This Article: ]|
|74.||Sawai H, Okada Y, Funahashi H, Matsuo Y, Tanaka M, Manabe T. Immunohistochemical analysis of molecular biological factors in intraductal papillary-mucinous tumors and mucinous cystic tumors of the pancreas. Scand J Gastroenterol. 2004;39:1159-1165. [Cited in This Article: ]|
|75.||Yeh MM, Tang LH, Wang S, Robert ME, Zheng W, Jain D. Inhibin expression in ovarian-type stroma in mucinous cystic neoplasms of the pancreas. Appl Immunohistochem Mol Morphol. 2004;12:148-152. [Cited in This Article: ]|
|76.||Suzuki Y, Atomi Y, Sugiyama M, Isaji S, Inui K, Kimura W, Sunamura M, Furukawa T, Yanagisawa A, Ariyama J. Cystic neoplasm of the pancreas: a Japanese multiinstitutional study of intraductal papillary mucinous tumor and mucinous cystic tumor. Pancreas. 2004;28:241-246. [Cited in This Article: ]|
|77.||Izumo A, Yamaguchi K, Eguchi T, Nishiyama K, Yamamoto H, Yonemasu H, Yao T, Tanaka M, Tsuneyoshi M. Mucinous cystic tumor of the pancreas: immunohistochemical assessment of "ovarian-type stroma". Oncol Rep. 2003;10:515-525. [Cited in This Article: ]|
|78.||Kim SG, Wu TT, Lee JH, Yun YK, Issa JP, Hamilton SR, Rashid A. Comparison of epigenetic and genetic alterations in mucinous cystic neoplasm and serous microcystic adenoma of pancreas. Mod Pathol. 2003;16:1086-1094. [Cited in This Article: ]|
|79.||Shimizu Y, Yasui K, Yamao K, Ohhashi K, Kato T, Yamamura Y, Hirai T, Kodera Y, Kanemitsu Y, Ito S. Possible oncogenesis of mucinous cystic tumors of the pancreas lacking ovarian-like stroma. Pancreatology. 2002;2:413-420. [Cited in This Article: ]|
|80.||Hara T, Kawashima H, Ishigooka M, Kashiyama M, Takanashi S, Yamazaki S, Hosokawa Y. Mucinous cystic tumors of the pancreas. Surg Today. 2002;32:965-969. [Cited in This Article: ]|
|81.||Yeh TS, Jan YY, Chiu CT, Ho YB, Chen TC, Lee KF, Chan KM, Hsu JC, Hwang TL, Chen MF. Characterisation of oestrogen receptor, progesterone receptor, trefoil factor 1, and epidermal growth factor and its receptor in pancreatic cystic neoplasms and pancreatic ductal adenocarcinoma. Gut. 2002;51:712-716. [Cited in This Article: ]|
|82.||Fujino Y, Suzuki Y, Ajiki T, Tanioka Y, Kuroda Y. Surgical treatment for mucin-producing tumors of the pancreas. Hepatogastroenterology. 2001;48:1157-1161. [Cited in This Article: ]|
|83.||Scott J, Martin I, Redhead D, Hammond P, Garden OJ. Mucinous cystic neoplasms of the pancreas: imaging features and diagnostic difficulties. Clin Radiol. 2000;55:187-192. [Cited in This Article: ]|
|84.||Shima Y, Mori M, Takakura N, Kimura T, Yagi T, Tanaka N. Diagnosis and management of cystic pancreatic tumours with mucin production. Br J Surg. 2000;87:1041-1047. [Cited in This Article: ]|
|85.||Yamaguchi K, Yokohata K, Noshiro H, Chijiiwa K, Tanaka M. Mucinous cystic neoplasm of the pancreas or intraductal papillary-mucinous tumour of the pancreas. Eur J Surg. 2000;166:141-148. [Cited in This Article: ]|
|86.||Thompson LD, Becker RC, Przygodzki RM, Adair CF, Heffess CS. Mucinous cystic neoplasm (mucinous cystadenocarcinoma of low-grade malignant potential) of the pancreas: a clinicopathologic study of 130 cases. Am J Surg Pathol. 1999;23:1-16. [Cited in This Article: ]|
|87.||Sugiyama M, Atomi Y, Kuroda A. Two types of mucin-producing cystic tumors of the pancreas: diagnosis and treatment. Surgery. 1997;122:617-625. [Cited in This Article: ]|
|88.||Fukushima N, Mukai K, Kanai Y, Hasebe T, Shimada K, Ozaki H, Kinoshita T, Kosuge T. Intraductal papillary tumors and mucinous cystic tumors of the pancreas: clinicopathologic study of 38 cases. Hum Pathol. 1997;28:1010-1017. [Cited in This Article: ]|
|89.||Shyr YM, Su CH, Tsay SH, Lui WY. Mucin-producing neoplasms of the pancreas. Intraductal papillary and mucinous cystic neoplasms. Ann Surg. 1996;223:141-146. [Cited in This Article: ]|
|90.||Kloppel G, Solcia E, Longnecker DS, Capella C, Sobin LH. Hystological typing of tumors of the exocrine pancreas. International Hystological Classification of Tumours. 2nd ed. Berlin: Springer Verlag 1996; 15-21. [Cited in This Article: ]|
|91.||Hruban RH, Pitman MB, Klimstra DS. Tumors of the pancreas: AFIP atlas of tumor pathology. Series 4, fascicle 6. Washington, DC: American Registry of Pathology 2007; 75-100. [Cited in This Article: ]|
|92.||Klöppel G, Kosmahl M. Cystic lesions and neoplasms of the pancreas. The features are becoming clearer. Pancreatology. 2001;1:648-655. [Cited in This Article: ]|
|93.||Hruban RH, Maitra A, Kern SE, Goggins M. Precursors to pancreatic cancer. Gastroenterol Clin North Am. 2007;36:831-849, vi. [Cited in This Article: ]|
|94.||Beger HG, Gansauge F, Siech M, Schwarz M, Poch B. Duodenum-preserving total pancreatic head resection for cystic neoplastic lesions in the head of the pancreas. J Hepatobiliary Pancreat Surg. 2008;15:149-156. [Cited in This Article: ]|
|95.||Garcea G, Ong SL, Rajesh A, Neal CP, Pollard CA, Berry DP, Dennison AR. Cystic lesions of the pancreas. A diagnostic and management dilemma. Pancreatology. 2008;8:236-251. [Cited in This Article: ]|
|96.||Yamao K, Nakamura T, Suzuki T, Sawaki A, Hara K, Kato T, Okubo K, Matsumoto K, Shimizu Y. Endoscopic diagnosis and staging of mucinous cystic neoplasms and intraductal papillary-mucinous tumors. J Hepatobiliary Pancreat Surg. 2003;10:142-146. [Cited in This Article: ]|
|97.||Volkan Adsay N. Cystic lesions of the pancreas. Mod Pathol. 2007;20 Suppl 1:S71-S93. [Cited in This Article: ]|
|98.||Zamboni G, Capelli P, Pesci A, Brighenti A. Pathology of cystic tumor. Imaging of the pancreas: cystic and rare tumors. Berlin: Springer-Verlag 2003; 9-30. [Cited in This Article: ]|
|99.||Wenig BM, Albores-Saavedra J, Buetow PC, Heffess CS. Pancreatic mucinous cystic neoplasm with sarcomatous stroma: a report of three cases. Am J Surg Pathol. 1997;21:70-80. [Cited in This Article: ]|
|100.||Posen JA. Giant cell tumor of the pancreas of the osteoclastic type associated with a mucous secreting cystadenocarcinoma. Hum Pathol. 1981;12:944-947. [Cited in This Article: ]|
|101.||Lüttges J, Feyerabend B, Buchelt T, Pacena M, Klöppel G. The mucin profile of noninvasive and invasive mucinous cystic neoplasms of the pancreas. Am J Surg Pathol. 2002;26:466-471. [Cited in This Article: ]|
|102.||Bloomston M, Chanona-Vilchis J, Ellison EC, Ramirez NC, Frankel WL. Carcinosarcoma of the pancreas arising in a mucinous cystic neoplasm. Am Surg. 2006;72:351-355. [Cited in This Article: ]|
|103.||Yamada M, Kozuka S, Yamao K, Nakazawa S, Naitoh Y, Tsukamoto Y. Mucin-producing tumor of the pancreas. Cancer. 1991;68:159-168. [Cited in This Article: ]|
|104.||Yoshizawa K, Nagai H, Sakurai S, Hironaka M, Morinaga S, Saitoh K, Fukayama M. Clonality and K-ras mutation analyses of epithelia in intraductal papillary mucinous tumor and mucinous cystic tumor of the pancreas. Virchows Arch. 2002;441:437-443. [Cited in This Article: ]|
|105.||Iacobuzio-Donahue CA, Wilentz RE, Argani P, Yeo CJ, Cameron JL, Kern SE, Hruban RH. Dpc4 protein in mucinous cystic neoplasms of the pancreas: frequent loss of expression in invasive carcinomas suggests a role in genetic progression. Am J Surg Pathol. 2000;24:1544-1548. [Cited in This Article: ]|
|106.||Fernández-del Castillo C, Targarona J, Thayer SP, Rattner DW, Brugge WR, Warshaw AL. Incidental pancreatic cysts: clinicopathologic characteristics and comparison with symptomatic patients. Arch Surg. 2003;138:427-433; discussion 433-434. [Cited in This Article: ]|
|107.||Sahani DV, Kadavigere R, Saokar A, Fernandez-del Castillo C, Brugge WR, Hahn PF. Cystic pancreatic lesions: a simple imaging-based classification system for guiding management. Radiographics. 2005;25:1471-1484. [Cited in This Article: ]|
|108.||Goh BK, Tan YM, Chung YF, Cheow PC, Ong HS, Chan WH, Chow PK, Soo KC, Wong WK, Ooi LL. Critical appraisal of 232 consecutive distal pancreatectomies with emphasis on risk factors, outcome, and management of the postoperative pancreatic fistula: a 21-year experience at a single institution. Arch Surg. 2008;143:956-965. [Cited in This Article: ]|
|109.||Brambs HJ, Juchems M. [Cystic tumors of the pancreas]. Radiologe. 2008;48:740-751. [Cited in This Article: ]|
|110.||Bassi C, Salvia R, Gumbs AA, Butturini G, Falconi M, Pederzoli P. The value of standard serum tumor markers in differentiating mucinous from serous cystic tumors of the pancreas: CEA, Ca 19-9, Ca 125, Ca 15-3. Langenbecks Arch Surg. 2002;387:281-285. [Cited in This Article: ]|
|111.||van der Waaij LA, van Dullemen HM, Porte RJ. Cyst fluid analysis in the differential diagnosis of pancreatic cystic lesions: a pooled analysis. Gastrointest Endosc. 2005;62:383-389. [Cited in This Article: ]|
|112.||Van Dam J. EUS in cystic lesions of the pancreas. Gastrointest Endosc. 2002;56:S91-S93. [Cited in This Article: ]|
|113.||Brugge WR, Lewandrowski K, Lee-Lewandrowski E, Centeno BA, Szydlo T, Regan S, del Castillo CF, Warshaw AL. Diagnosis of pancreatic cystic neoplasms: a report of the cooperative pancreatic cyst study. Gastroenterology. 2004;126:1330-1336. [Cited in This Article: ]|
|114.||Fernández-del Castillo C, Alsfasser G, Targarona J, Brugge WR, Warshaw AL. Serum CA 19-9 in the management of cystic lesions of the pancreas. Pancreas. 2006;32:220. [Cited in This Article: ]|
|115.||Hernandez LV, Mishra G, Forsmark C, Draganov PV, Petersen JM, Hochwald SN, Vogel SB, Bhutani MS. Role of endoscopic ultrasound (EUS) and EUS-guided fine needle aspiration in the diagnosis and treatment of cystic lesions of the pancreas. Pancreas. 2002;25:222-228. [Cited in This Article: ]|
|116.||Sedlack R, Affi A, Vazquez-Sequeiros E, Norton ID, Clain JE, Wiersema MJ. Utility of EUS in the evaluation of cystic pancreatic lesions. Gastrointest Endosc. 2002;56:543-547. [Cited in This Article: ]|
|117.||Frossard JL, Amouyal P, Amouyal G, Palazzo L, Amaris J, Soldan M, Giostra E, Spahr L, Hadengue A, Fabre M. Performance of endosonography-guided fine needle aspiration and biopsy in the diagnosis of pancreatic cystic lesions. Am J Gastroenterol. 2003;98:1516-1524. [Cited in This Article: ]|
|118.||Ahmad NA, Kochman ML, Brensinger C, Brugge WR, Faigel DO, Gress FG, Kimmey MB, Nickl NJ, Savides TJ, Wallace MB. Interobserver agreement among endosonographers for the diagnosis of neoplastic versus non-neoplastic pancreatic cystic lesions. Gastrointest Endosc. 2003;58:59-64. [Cited in This Article: ]|
|119.||Ahmad NA, Kochman ML, Lewis JD, Ginsberg GG. Can EUS alone differentiate between malignant and benign cystic lesions of the pancreas? Am J Gastroenterol. 2001;96:3295-3300. [Cited in This Article: ]|
|120.||Koito K, Namieno T, Nagakawa T, Shyonai T, Hirokawa N, Morita K. Solitary cystic tumor of the pancreas: EUS-pathologic correlation. Gastrointest Endosc. 1997;45:268-276. [Cited in This Article: ]|
|121.||Sahani D, Prasad S, Saini S, Mueller P. Cystic pancreatic neoplasms evaluation by CT and magnetic resonance cholangiopancreatography. Gastrointest Endosc Clin N Am. 2002;12:657-672. [Cited in This Article: ]|
|122.||Sarr MG, Murr M, Smyrk TC, Yeo CJ, Fernandez-del-Castillo C, Hawes RH, Freeny PC. Primary cystic neoplasms of the pancreas. Neoplastic disorders of emerging importance-current state-of-the-art and unanswered questions. J Gastrointest Surg. 2003;7:417-428. [Cited in This Article: ]|
|123.||Mathieu D, Guigui B, Valette PJ, Dao TH, Bruneton JN, Bruel JM, Pringot J, Vasile N. Pancreatic cystic neoplasms. Radiol Clin North Am. 1989;27:163-176. [Cited in This Article: ]|
|124.||Planner AC, Anderson EM, Slater A, Phillips-Hughes J, Bungay HK, Betts M. An evidence-based review for the management of cystic pancreatic lesions. Clin Radiol. 2007;62:930-937. [Cited in This Article: ]|
|125.||Curry CA, Eng J, Horton KM, Urban B, Siegelman S, Kuszyk BS, Fishman EK. CT of primary cystic pancreatic neoplasms: can CT be used for patient triage and treatment? AJR Am J Roentgenol. 2000;175:99-103. [Cited in This Article: ]|
|126.||Loftus EV Jr, Olivares-Pakzad BA, Batts KP, Adkins MC, Stephens DH, Sarr MG, DiMagno EP. Intraductal papillary-mucinous tumors of the pancreas: clinicopathologic features, outcome, and nomenclature. Members of the Pancreas Clinic, and Pancreatic Surgeons of Mayo Clinic. Gastroenterology. 1996;110:1909-1918. [Cited in This Article: ]|
|127.||Zhong L. Magnetic resonance imaging in the detection of pancreatic neoplasms. J Dig Dis. 2007;8:128-132. [Cited in This Article: ]|
|128.||Kim MJ, Mitchell DG, Ito K, Outwater EK. Biliary dilatation: differentiation of benign from malignant causes--value of adding conventional MR imaging to MR cholangiopancreatography. Radiology. 2000;214:173-181. [Cited in This Article: ]|
|129.||Manfredi R, Costamagna G, Brizi MG, Maresca G, Vecchioli A, Colagrande C, Marano P. Severe chronic pancreatitis versus suspected pancreatic disease: dynamic MR cholangiopancreatography after secretin stimulation. Radiology. 2000;214:849-855. [Cited in This Article: ]|
|130.||Hawes RH, Xiong Q, Waxman I, Chang KJ, Evans DB, Abbruzzese JL. A multispecialty approach to the diagnosis and management of pancreatic cancer. Am J Gastroenterol. 2000;95:17-31. [Cited in This Article: ]|
|131.||Trede M, Rumstadt B, Wendl K, Gaa J, Tesdal K, Lehmann KJ, Meier-Willersen HJ, Pescatore P, Schmoll J. Ultrafast magnetic resonance imaging improves the staging of pancreatic tumors. Ann Surg. 1997;226:393-405; discussion 405-407. [Cited in This Article: ]|
|132.||Sperti C, Pasquali C, Chierichetti F, Liessi G, Ferlin G, Pedrazzoli S. Value of 18-fluorodeoxyglucose positron emission tomography in the management of patients with cystic tumors of the pancreas. Ann Surg. 2001;234:675-680. [Cited in This Article: ]|
|133.||Sperti C, Pasquali C, Decet G, Chierichetti F, Liessi G, Pedrazzoli S. F-18-fluorodeoxyglucose positron emission tomography in differentiating malignant from benign pancreatic cysts: a prospective study. J Gastrointest Surg. 2005;9:22-28; discussion 28-29. [Cited in This Article: ]|
|134.||Rodríguez JR, Germes SS, Pandharipande PV, Gazelle GS, Thayer SP, Warshaw AL, Fernández-del Castillo C. Implications and cost of pancreatic leak following distal pancreatic resection. Arch Surg. 2006;141:361-365; discussion 366. [Cited in This Article: ]|
|135.||Lillemoe KD, Kaushal S, Cameron JL, Sohn TA, Pitt HA, Yeo CJ. Distal pancreatectomy: indications and outcomes in 235 patients. Ann Surg. 1999;229:693-698; discussion 698-700. [Cited in This Article: ]|
|136.||Bassi C, Falconi M, Molinari E, Salvia R, Butturini G, Sartori N, Mantovani W, Pederzoli P. Reconstruction by pancreaticojejunostomy versus pancreaticogastrostomy following pancreatectomy: results of a comparative study. Ann Surg. 2005;242:767-771, discussion 771-773. [Cited in This Article: ]|
|137.||Mayo WJ. I. The Surgery of the Pancreas: I. Injuries to the Pancreas in the Course of Operations on the Stomach. II. Injuries to the Pancreas in the Course of Operations on the Spleen. III. Resection of Half the Pancreas for Tumor. Ann Surg. 1913;58:145-150. [Cited in This Article: ]|
|138.||Mallet-Guy P, Vachon A. Pancreatites Chroniques Gauches. Paris: Masson 1943; . [Cited in This Article: ]|
|139.||Warshaw AL. Conservation of the spleen with distal pancreatectomy. Arch Surg. 1988;123:550-553. [Cited in This Article: ]|
|140.||Miura F, Takada T, Asano T, Kenmochi T, Ochiai T, Amano H, Yoshida M. Hemodynamic changes of splenogastric circulation after spleen-preserving pancreatectomy with excision of splenic artery and vein. Surgery. 2005;138:518-522. [Cited in This Article: ]|
|141.||Richardson DQ, Scott-Conner CE. Distal pancreatectomy with and without splenectomy. A comparative study. Am Surg. 1989;55:21-25. [Cited in This Article: ]|
|142.||Aldridge MC, Williamson RC. Distal pancreatectomy with and without splenectomy. Br J Surg. 1991;78:976-979. [Cited in This Article: ]|
|143.||Warshaw AL, Rattner DW, Fernández-del Castillo C, Z'graggen K. Middle segment pancreatectomy: a novel technique for conserving pancreatic tissue. Arch Surg. 1998;133:327-331. [Cited in This Article: ]|
|144.||Kahl S, Malfertheiner P. Exocrine and endocrine pancreatic insufficiency after pancreatic surgery. Best Pract Res Clin Gastroenterol. 2004;18:947-955. [Cited in This Article: ]|
|145.||Aranha GV, Shoup M. Nonstandard pancreatic resections for unusual lesions. Am J Surg. 2005;189:223-228. [Cited in This Article: ]|
|146.||Crippa S, Bassi C, Warshaw AL, Falconi M, Partelli S, Thayer SP, Pederzoli P, Fernández-del Castillo C. Middle pancreatectomy: indications, short- and long-term operative outcomes. Ann Surg. 2007;246:69-76. [Cited in This Article: ]|
|147.||Roggin KK, Rudloff U, Blumgart LH, Brennan MF. Central pancreatectomy revisited. J Gastrointest Surg. 2006;10:804-812. [Cited in This Article: ]|
|148.||Bassi C. Middle segment pancreatectomy: a useful tool in the management of pancreatic neoplasms. J Gastrointest Surg. 2007;11:421-424. [Cited in This Article: ]|
|149.||Christein JD, Smoot RL, Farnell MB. Central pancreatectomy: a technique for the resection of pancreatic neck lesions. Arch Surg. 2006;141:293-299. [Cited in This Article: ]|
|150.||Rotman N, Sastre B, Fagniez PL. Medial pancreatectomy for tumors of the neck of the pancreas. Surgery. 1993;113:532-535. [Cited in This Article: ]|
|151.||Falconi M, Mantovani W, Frigerio I, Mascetta G, Sargenti M, Tardivo S, Salvia R, Bassi C, Pederzoli P. [Intermediate resection and distal pancreatectomy for benign neoplasms of the pancreas: comparison of postoperative complications and costs]. Chir Ital. 2001;53:467-474. [Cited in This Article: ]|
|152.||Howard TJ, Jones JW, Sherman S, Fogel E, Lehman GA. Impact of pancreatic head resection on direct medical costs in patients with chronic pancreatitis. Ann Surg. 2001;234:661-667. [Cited in This Article: ]|
|153.||Hines OJ, Reber HA. Median pancreatectomy: do the risks justify the effort? J Am Coll Surg. 2000;190:715-716. [Cited in This Article: ]|
|154.||Dagradi A, Serio G. Pancreatectomia intermedia. Enciclopedia Medica Italiana: Pancreas, vol 11. Florence: Scientifiche 1984; 850-851. [Cited in This Article: ]|
|155.||Iacono C, Bortolasi L, Serio G. Is there a place for central pancreatectomy in pancreatic surgery? J Gastrointest Surg. 1998;2:509-516; discussion 516-517. [Cited in This Article: ]|
|156.||Sperti C, Pasquali C, Ferronato A, Pedrazzoli S. Median pancreatectomy for tumors of the neck and body of the pancreas. J Am Coll Surg. 2000;190:711-716. [Cited in This Article: ]|
|157.||Bassi C, Dervenis C, Butturini G, Fingerhut A, Yeo C, Izbicki J, Neoptolemos J, Sarr M, Traverso W, Buchler M. Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery. 2005;138:8-13. [Cited in This Article: ]|
|158.||Crippa S, Bassi C, Salvia R, Falconi M, Butturini G, Pederzoli P. Enucleation of pancreatic neoplasms. Br J Surg. 2007;94:1254-1259. [Cited in This Article: ]|
|159.||Talamini MA, Moesinger R, Yeo CJ, Poulose B, Hruban RH, Cameron JL, Pitt HA. Cystadenomas of the pancreas: is enucleation an adequate operation? Ann Surg. 1998;227:896-903. [Cited in This Article: ]|
|160.||Kiely JM, Nakeeb A, Komorowski RA, Wilson SD, Pitt HA. Cystic pancreatic neoplasms: enucleate or resect? J Gastrointest Surg. 2003;7:890-897. [Cited in This Article: ]|
|161.||Bassi C, Falconi M, Salvia R, Mascetta G, Molinari E, Pederzoli P. Management of complications after pancreaticoduodenectomy in a high volume centre: results on 150 consecutive patients. Dig Surg. 2001;18:453-457; discussion 458. [Cited in This Article: ]|
|162.||Horvath KD, Chabot JA. An aggressive resectional approach to cystic neoplasms of the pancreas. Am J Surg. 1999;178:269-274. [Cited in This Article: ]|
|163.||Yasuda H, Takada T, Amano H, Yoshida M. Surgery for mucin-producing pancreatic tumor. Hepatogastroenterology. 1998;45:2009-2015. [Cited in This Article: ]|
|164.||Beger HG, Büchler M, Bittner RR, Oettinger W, Roscher R. Duodenum-preserving resection of the head of the pancreas in severe chronic pancreatitis. Early and late results. Ann Surg. 1989;209:273-278. [Cited in This Article: ]|
|165.||Nakao A. Pancreatic head resection with segmental duodenectomy and preservation of the gastroduodenal artery. Hepatogastroenterology. 1998;45:533-535. [Cited in This Article: ]|
|166.||Isaji S, Kawarada Y. Pancreatic head resection with second-portion duodenectomy for benign lesions, low-grade malignancies, and early stage carcinomas involving the pancreatic head region. Am J Surg. 2001;181:172-176. [Cited in This Article: ]|
|167.||Nakao A, Fernández-Cruz L. Pancreatic head resection with segmental duodenectomy: safety and long-term results. Ann Surg. 2007;246:923-928; discussion 929-931. [Cited in This Article: ]|
|168.||Pan ZG, Wang B. Anaplastic carcinoma of the pancreas associated with a mucinous cystic adenocarcinoma. A case report and review of the literature. JOP. 2007;8:775-782. [Cited in This Article: ]|
|169.||Melotti G, Butturini G, Piccoli M, Casetti L, Bassi C, Mullineris B, Lazzaretti MG, Pederzoli P. Laparoscopic distal pancreatectomy: results on a consecutive series of 58 patients. Ann Surg. 2007;246:77-82. [Cited in This Article: ]|
|170.||Takaori K, Tanigawa N. Laparoscopic pancreatic resection: the past, present, and future. Surg Today. 2007;37:535-545. [Cited in This Article: ]|
|171.||Fernández-Cruz L, Pardo F, Cugat E, Artigas V, Olsina J, Rotellar F, Carrillo A, Díaz H, Hernández J, Targarona E. [Analysis of the Spanish National Registry of Laparoscopic Pancreatic Surgery]. Cir Esp. 2006;79:293-298. [Cited in This Article: ]|
|172.||Fernández-Cruz L, Sáenz A, Astudillo E, Martinez I, Hoyos S, Pantoja JP, Navarro S. Outcome of laparoscopic pancreatic surgery: endocrine and nonendocrine tumors. World J Surg. 2002;26:1057-1065. [Cited in This Article: ]|
|173.||Fabre JM, Dulucq JL, Vacher C, Lemoine MC, Wintringer P, Nocca D, Burgel JS, Domergue J. Is laparoscopic left pancreatic resection justified? Surg Endosc. 2002;16:1358-1361. [Cited in This Article: ]|
|174.||Mabrut JY, Fernandez-Cruz L, Azagra JS, Bassi C, Delvaux G, Weerts J, Fabre JM, Boulez J, Baulieux J, Peix JL. Laparoscopic pancreatic resection: results of a multicenter European study of 127 patients. Surgery. 2005;137:597-605. [Cited in This Article: ]|
|175.||Fernández-Cruz L, Martínez I, Gilabert R, Cesar-Borges G, Astudillo E, Navarro S. Laparoscopic distal pancreatectomy combined with preservation of the spleen for cystic neoplasms of the pancreas. J Gastrointest Surg. 2004;8:493-501. [Cited in This Article: ]|
|176.||Burris HA 3rd, Moore MJ, Andersen J, Green MR, Rothenberg ML, Modiano MR, Cripps MC, Portenoy RK, Storniolo AM, Tarassoff P. Improvements in survival and clinical benefit with gemcitabine as first-line therapy for patients with advanced pancreas cancer: a randomized trial. J Clin Oncol. 1997;15:2403-2413. [Cited in This Article: ]|
|177.||Shimada K, Iwase K, Aono T, Takeda S, Yoshida H, Koma M, Nomura M, Nishikawa K, Tamagawa H, Matsuda C. A case of advanced mucinous cystadenocarcinoma of the pancreas with peritoneal dissemination responding to gemcitabine. Gan To Kagaku Ryoho. 2009;36:995-998. [Cited in This Article: ]|
|178.||Obayashi K, Ohwada S, Sunose Y, Yamamoto K, Igarashi R, Hamada K, Takeyoshi I, Horiuchi R. [Remarkable effect of gemcitabine-oxaliplatin (GEMOX) therapy in a patient with advanced metastatic mucinous cystic neoplasm of the pancreas]. Gan To Kagaku Ryoho. 2008;35:1915-1917. [Cited in This Article: ]|
|179.||Moore MJ, Hamm J, Dancey J, Eisenberg PD, Dagenais M, Fields A, Hagan K, Greenberg B, Colwell B, Zee B. Comparison of gemcitabine versus the matrix metalloproteinase inhibitor BAY 12-9566 in patients with advanced or metastatic adenocarcinoma of the pancreas: a phase III trial of the National Cancer Institute of Canada Clinical Trials Group. J Clin Oncol. 2003;21:3296-3302. [Cited in This Article: ]|
|180.||Berlin JD, Adak S, Vaughn DJ, Flinker D, Blaszkowsky L, Harris JE, Benson IIIAB. A phase II study of gemcitabine and 5-fluorouracil in metastatic pancreatic cancer: an Eastern Cooperative Oncology Group Study (E3296). Oncology. 2000;58:215-218. [Cited in This Article: ]|
|181.||Van Cutsem E, van de Velde H, Karasek P, Oettle H, Vervenne WL, Szawlowski A, Schoffski P, Post S, Verslype C, Neumann H. Phase III trial of gemcitabine plus tipifarnib compared with gemcitabine plus placebo in advanced pancreatic cancer. J Clin Oncol. 2004;22:1430-1438. [Cited in This Article: ]|
|182.||Xiong HQ, Rosenberg A, LoBuglio A, Schmidt W, Wolff RA, Deutsch J, Needle M, Abbruzzese JL. Cetuximab, a monoclonal antibody targeting the epidermal growth factor receptor, in combination with gemcitabine for advanced pancreatic cancer: a multicenter phase II Trial. J Clin Oncol. 2004;22:2610-2616. [Cited in This Article: ]|
|183.||Kindler HL, Friberg G, Singh DA, Locker G, Nattam S, Kozloff M, Taber DA, Karrison T, Dachman A, Stadler WM. Phase II trial of bevacizumab plus gemcitabine in patients with advanced pancreatic cancer. J Clin Oncol. 2005;23:8033-8040. [Cited in This Article: ]|
|184.||Van Cutsem E, Vervenne WL, Bennouna J, Humblet Y, Gill S, Van Laethem JL, Verslype C, Scheithauer W, Shang A, Cosaert J. Phase III trial of bevacizumab in combination with gemcitabine and erlotinib in patients with metastatic pancreatic cancer. J Clin Oncol. 2009;27:2231-2237. [Cited in This Article: ]|
|185.||Rivera F, López-Tarruella S, Vega-Villegas ME, Salcedo M. Treatment of advanced pancreatic cancer: from gemcitabine single agent to combinations and targeted therapy. Cancer Treat Rev. 2009;35:335-339. [Cited in This Article: ]|
|186.||Garcea G, Dennison AR, Pattenden CJ, Neal CP, Sutton CD, Berry DP. Survival following curative resection for pancreatic ductal adenocarcinoma. A systematic review of the literature. JOP. 2008;9:99-132. [Cited in This Article: ]|