Diagnosis and treatment of pancreatic incidentalomas. An overview

AIM: The aim of this study is to describe the incidence, imaging characteristics and pathological features of pancreatic incidentalomas. Moreover, surgical indications are discussed according to the nature and location of the neoplasms. BACKGROUND: Pancreatic incidental lesions are more commonly diagnosed, due to the widespread of high quality cross sectional imaging. These lesions can be cystic or solid, benign, pre-malignant or already malignant and they cover a wide spectrum of histological diagnosis. Cystic lesions are more commonly benign or at least pre-malignant. Surgery should be reserved in case of unexpected changes in aspect during follow-up or for large cysts (>3 cm). Among solid pancreatic incidentalomas, ductal adenocarcinoma is the most common diagnosis, followed by neuroendocrine tumors. Surgical treatment of pancreatic incidentaloma depends on the location of the tumor: a Whipple's procedure should be performed for neoplasms of the head, while distal pancreatectomy is indicated for body and tail lesions. Pancreatic surgery is still delicate and burdened by serious complications. Both procedures can be performed with minimally-invasive technique which is connected to lower complications rate but, at present, they have shown no advantages in terms of mortality and oncologic outcomes. CONCLUSIONS: Pancreatic incidentalomas are becoming more and more common but when and how to operate them is still subject of debate. Precise criteria about treatment strategy are still lacking and definite guidelines are needed to clarify the best approach.