From the Guidelines
A benign pancreatic mass requires careful evaluation and management, with the recommended approach beginning with complete diagnostic imaging, typically including contrast-enhanced CT scan and possibly endoscopic ultrasound with fine needle aspiration for tissue sampling, as outlined in the most recent guidelines 1. The management of a benign pancreatic mass depends on the specific type of mass identified.
- Serous cystadenomas generally require monitoring with periodic imaging if asymptomatic and small.
- Intraductal papillary mucinous neoplasms (IPMNs) need surveillance according to size and features, with surgical resection recommended for main duct involvement or concerning features, as per the Sendai guidelines 1.
- Mucinous cystic neoplasms typically warrant surgical removal due to malignant potential.
- Pseudocysts may resolve spontaneously or require drainage if symptomatic or enlarging.
- Solid pseudopapillary neoplasms should be surgically resected even when benign.
- Pancreatic neuroendocrine tumors usually need surgical intervention based on size and functionality, with resection together with lymph node dissection recommended for larger or malignant-appearing tumors 1. Regular follow-up is essential for all benign pancreatic masses, with surveillance intervals determined by the specific diagnosis and risk factors, as recommended by the American College of Radiology Appropriateness Criteria 1. This approach balances the need to prevent progression to malignancy while avoiding unnecessary surgery for truly benign lesions that pose minimal risk, and is supported by the latest evidence on pancreatic cancer diagnosis and treatment 1.
From the Research
Benign Pancreatic Mass
- A benign pancreatic mass is a type of non-cancerous growth in the pancreas, which can be similar in radiographic appearance to some malignant lesions 2
- The correct differentiation of these malignant and premalignant lesions from their benign counterpart is crucial for proper management 2
Treatment Options
- Treatment options for benign pancreatic masses may include surgical resection, such as pancreaticoduodenectomy or distal pancreatectomy 3, 4
- The use of somatostatin analogues, such as octreotide, has been investigated to reduce postoperative complications, including pancreatic fistula, after pancreatic surgery 3, 5, 4, 6
- Studies have shown that somatostatin analogues may reduce perioperative complications, but do not reduce perioperative mortality 4
Somatostatin Analogues
- Somatostatin analogues have been used to inhibit exocrine pancreatic secretion and reduce complications after pancreatic surgery 5, 4
- The efficacy of prophylactic octreotide to reduce postoperative pancreatic fistula after pancreaticoduodenectomy remains open to debate 3
- Meta-analyses have shown that somatostatin analogues may have a protective effect on morbidity and pancreatic fistula after pancreatic resection, but the effect may vary depending on the type of pancreatic resection and the specific somatostatin analogue used 6