Radical surgery following inadequate drainage procedures for cystic neoplasms of the pancreas

BACKGROUND: Despite the presence of national and international recommendations on the diagnostics and treatment of cystic lesions in the pancreas, the consequences of inappropriate drainage procedures for pancreatic cystic neoplasms mistaken for the post-necrotic pancreatic pseudocysts, remain only fragmentally researched and are mainly presented by single observations or small case series without the detailed analysis of the delay of the radical intervention and of the effects of previous surgeries on the complexity and on the immediate results of resection. Reminding about this problem based on the analysis of our own clinical experience is important for the prevention of such tactical mistakes. AIM: The analysis of the remote results and of the consequences of non-radical draining surgeries conducted in patients with pancreatic cystic neoplasms, initially mistakenly diagnosed as benign pancreatic cysts. METHODS: From January 2016 until February 2025, out of the 177 patients with previous resection interventions in the pancreas due to having the cystic lesions, a group of 19 (10.7%) patients was isolated, which previously underwent the non-radical draining surgeries. A retrospective analysis was arranged on the data of their treatment and the postoperative complications, as well as the comparison of preoperative diagnoses to the data from the definitive histological examination. RESULTS: All the 19 patients with a past draining intervention had a reported recurrence of the cystic lesion within the period from 2 weeks to 84 months (with the median of 6 months). During the repeated pre-operative examination, the following conditions were diagnosed: mucinous cystic neoplasm (15; 78.9%), main-duct intraductal papillary mucinous neoplasm (2; 10.5%), solid pseudopapillary neoplasm (1; 5.3%), and suspected adenocarcinoma (1; 5.3%). All the patients underwent the radical resections: the pancreaticoduodenectomy (in 4) and the distal pancreatectomy (in 15). The complications of grade III and higher acc. to the classification by Clavien–Dindo were developing in 5 (26.3%) patients, there were no deaths. The definitive histological diagnosis has confirmed the preoperative conclusion on the mucinous cystic neoplasm in 86.7% of the cases (13/15); other cases were the verified serous cystadenoma and the solid pseudopapillary neoplasm. The diagnoses of the solid pseudopapillary neoplasm and the adenocarcinoma, set before surgery, were completely matching to the morphological data. CONCLUSION: The patients with cystic lesions in the pancreas must receive the comprehensive examination at the pre-operative stage for the precise differential diagnostics of the post-necrotic cysts and the cystic tumor. The inappropriate drainage procedures in cases of cystic tumor in the pancreas does not lead to recovery, it delays the radical surgery, which can complicate its further course and worsen the treatment prognosis.