Pancreatic Club Perspectives on Surgical Approach, Post-Resection Follow-Up, and Role of Endoscopic Ablation on Pancreatic Cystic Neoplasms

Sep 23, 2026

Uploaded by Mary Man

Pancreatic cystic neoplasms (PCNs) carry malignant potential and require management tailored to clinical and morphological criteria to support cancer prevention while avoiding unnecessary intervention. Surgical resection remains the standard for high-risk PCNs, whereas low-risk PCNs are monitored with imaging to reduce the non-trivial likelihood of postoperative complications. Endoscopic ultrasound (EUS)-guided therapies, including injection and radiofrequency ablation, may provide a minimally invasive option for patients unfit for surgery, though their effect on mortality is still uncertain.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages12

Reading Time30 min

AccessFree to download

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GE – Portuguese Journal of Gastroenterology Review Article GE Port J Gastroenterol DOI: 10. 1159/000548201 Received: March 29, 2025 Accepted: July 7, 2025 Published online: August 28, 2025 Pancreatic Club Perspectives on Surgical Approach, Post-Resection Follow-Up, and Role of Endoscopic Ablation on Pancreatic Cystic Neoplasms Miguel Martinsa, b Carlota Branco c Miguel Bispod Alexandra Fernandes e Eduardo Rodrigues-Pintoa, b Tiago Cúrdia Gonçalvesf, g, h Filipe Vilas-Boasa, b Jorge Paulino c On behalf of the Portuguese Pancreatic Club specialized section of the Portuguese Society of Gastroenterology aGastroenterology Department, Centro Hospitalar Universitário de São João, Porto, Portugal; bFaculty of Medicine of the University of Porto, Porto, Portugal; cLuz Hospital Lisboa, Lisbon, Portugal; dDigestive Oncology Unit, Champalimaud Foundation, Lisbon, Portugal; eGastroenterology Department, Centro Hospitalar de Leiria, Leiria, Portugal; fGastroenterology Department, Unidade Local de Saúde do Alto Ave – Hospital de Guimarães, Guimaraes, Portugal; gSchool of Medicine, University of Minho, Braga, Portugal; hICVS/3B’s–PT Government Associate Laboratory, Braga, Portugal Keywords Pancreatic cyst neoplasms · Intraductal papillary mucinous neoplasm · Pancreatic surgery · Endosonography · Endoscopic ablation · Postoperative follow-up Abstract Background: Pancreatic cystic neoplasms (PCNs) are lesions with malignant potential that should be addressed differently according to clinical/morphological criteria, to ensure appropriate cancer prevention and while avoiding overtreatment. Summary: Surgical resection remains the gold standard for high-risk PCNs (at least one high-risk stigmata, multiple “worrisome” features), whereas low-risk PCNs should be monitored through imaging to mitigate the non-negligible risk of postoperative complications. Endoscopic ultrasound (EUS)-guided therapies, such as injection or radiofrequency, may offer a minimally invasive and effective therapeutic option particularly for patients unfit for surgery, although their impact on prognostic (i.e., mortality) remains uncertain. Key Messages: This review summarizes the latest recommendations on surgical management and post-resection follow-up of PCNs and the potential role of EUS ablationin the treatment algorithm. © 2025 The Author(s) . Published by S. Karger AG, Basel Miguel Martins and Carlota Branco share co-first authorship. [karger@karger.com](karger@karger.com)[ ](karger@karger.com)[www.karger.com/pjg](www.karger.com/pjg) © 2025 The Author(s) . Published by S. Karger AG, Basel This article is licensed under the Creative Commons AttributionNonCommercial 4.0 International License (CC BY-NC) ([https://](https://)[ ](https://)[karger.com/Services/OpenAccessLicense](karger.com/Services/OpenAccessLicense)). Usage and distribution for commercial purposes requires written permission. Perspetiva do Clube Português do Pâncreas sobre aabordagem cirúrgica, o seguimento pós-ressecção epapel da ablação endoscópica das neoplasia císticaspancreáticas Palavras Chave Neoplasias císticas pancreáticas · Neoplasia mucinosaspapilar intraductal · Cirurgia pancreática · Ecoendoscopia · Ablação endoscópica · Seguimento pós-operatório Resumo Introdução: As neoplasias císticas pancreáticas (NCPs) são lesões com potential maligno e devem ser estratificadas de acordo com critérios clínicos/morfológicos, deforma a assegurar um equilíbrio entre a progressão para cancro e evitar intervenções desnecessárias. Sumário: Otratamento cirúrgico é a atitude de primeira linha para NCPs de alto risco (pelo menos 1 estigma de alto risco, múltiplas características preocupantes), enquanto os NCPs de baixo risco devem ser vigiados imagiologicamente para mitigar o risco não-negligenciável decomplicações pós-operatórias. As terapêuticas guiadaspor ultrassonografia endoscópica, como a ablação e radiofrequência, podem ser opções terapêuticas minimamente i

FAQs

Why must pancreatic cystic neoplasms (PCNs) be managed using clinical and morphological criteria?

PCNs have malignant potential, so stratification by clinical and morphological features helps enable appropriate cancer prevention while avoiding overtreatment and unnecessary procedures.

What is the recommended approach for high-risk versus low-risk PCNs?

High-risk PCNs should be treated with surgical resection, while low-risk PCNs should be monitored through imaging to mitigate the risk of postoperative complications.

How do EUS-guided endoscopic therapies fit into the treatment strategy?

EUS-guided ablation therapies such as injection or radiofrequency may offer minimally invasive treatment for patients not suitable for surgery, but their impact on prognostic outcomes like mortality remains uncertain.

Sep 23, 2026

Uploaded by Mary Man