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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MSK Authors
  1. Murray F Brennan
    781 Brennan
  2. Ronald P DeMatteo
    602 DeMatteo
  3. Mithat Gonen
    716 Gonen
  4. Peter Allen
    442 Allen
  5. William R Jarnagin
    596 Jarnagin
  6. T Peter Kingham
    293 Kingham
  7. Mark Schattner
    103 Schattner
  8. Marc   Attiyeh
    23 Attiyeh
  9. Kenneth Seier
    23 Seier