Should patients with cystic lesions of the pancreas undergo long-term radiographic surveillance? Results of 3024 patients evaluated at a single institution Conference Paper
| Authors: | Lawrence, S. A.; Attiyeh, M. A.; Seier, K.; Gönen, M.; Schattner, M.; Haviland, D. L.; Balachandran, V. P.; Kingham, T. P.; D'Angelica, M. I.; DeMatteo, R. P.; Brennan, M. F.; Jarnagin, W. R.; Allen, P. J. |
| Title: | Should patients with cystic lesions of the pancreas undergo long-term radiographic surveillance? Results of 3024 patients evaluated at a single institution |
| Conference Title: | 137th Annual Meeting of the American Surgical Association (ASA) |
| Abstract: | Objective: In 2015, the American Gastroenterological Association recommended the discontinuation of radiographic surveillance after 5 years for patients with stable pancreatic cysts. The current study evaluated the yield of continued surveillance of pancreatic cysts up to and after 5 years of follow up. Methods: A prospectively maintained registry of patients evaluated for pancreatic cysts was queried (1995-2016). Patients who initially underwent radiographic surveillance were divided into those with <5 years and ≥5 years of follow up. Analyses for the presence of cyst growth (>5 mm increase in diameter), cross-over to resection, and development of carcinoma were performed. Results: A total of 3024 patients were identified, with 2472 (82%) undergoing initial surveillance. The ≥5 year group (n = 596) experienced a greater frequency of cyst growth (44% vs. 20%; P < 0.0001), a lower rate of cross-over to resection (8% vs 11%; P = 0.02), and a similar frequency of progression to carcinoma (2% vs 3%; P = 0.07) compared with the <5 year group (n = 1876). Within the ≥5 year group, 412 patients (69%) had demonstrated radiographic stability at the 5-year time point. This subgroup, when compared with the <5 year group, experienced similar rates of cyst growth (19% vs. 20%; P= 0.95) and lower rates of cross-over to resection (5% vs 11%; P< 0.0001) and development of carcinoma (1% vs 3%; P= 0.008). The observed rate of developing cancer in the group that was stable at the 5-year time point was 31.3 per 100,000 per year, whereas the expected national age-adjusted incidence rate for this same group was 7.04 per 100,000 per year. Conclusion: Cyst size stability at the 5-year time point did not preclude future growth, cross-over to resection, or carcinoma development. Patients who were stable at 5 years had a nearly 3-fold higher risk of developing cancer compared with the general population and should continue long-term surveillance. © 2017 Wolters Kluwer Health, Inc. All rights reserved. |
| Keywords: | pancreas; pancreas cyst; resection; surveillance; intraductal papillary mucinous neoplasm; mucinous cystic neoplasm; pancreatic ductal adenocarcinoma; serous cystadenoma |
| Journal Title | Annals of Surgery |
| Volume: | 266 |
| Issue: | 3 |
| Conference Dates: | 2017 Apr 20-22 |
| Conference Location: | Philadelphia, PA |
| ISBN: | 0003-4932 |
| Publisher: | Lippincott Williams & Wilkins |
| Date Published: | 2017-09-01 |
| Start Page: | 536 |
| End Page: | 544 |
| Language: | English |
| DOI: | 10.1097/sla.0000000000002371 |
| PROVIDER: | scopus |
| PUBMED: | 28657939 |
| DOI/URL: | |
| Notes: | Article -- Export Date: 1 September 2017 -- Source: Scopus |
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