A selective approach to the resection of cystic lesions of the pancreas: Results from 539 consecutive patients Journal Article
| Authors: | Allen, P. J.; D'Angelica, M.; Gonen, M.; Jaques, D. P.; Coit, D. G.; Jarnagin, W. R.; DeMatteo, R.; Fong, Y.; Blumgart, L. H.; Brennan, M. F. |
| Article Title: | A selective approach to the resection of cystic lesions of the pancreas: Results from 539 consecutive patients |
| Abstract: | OBJECTIVE: To define a group of patients with pancreatic cysts who do not require resection. SUMMARY BACKGROUND DATA: The increased use of cross-sectional imaging has resulted in an increased identification of small, asymptomatic pancreatic cysts. Data have not been available to determine which lesions should be resected. METHODS: All patients evaluated at our institution between January 1995 and January 2005 for the ICD-9 diagnosis of pancreatic cyst were reviewed. Analysis was performed to identify associations between patient and cyst characteristics, and selection of operative or nonoperative management. RESULTS: Pancreatic cysts were evaluated in 539 patients. Initial management was operative in 170 patients (32%), and nonoperative (radiographic follow-up) in 369 patients (68%). Factors associated with initial operative management included presence of a solid component (45% vs. 6%, P < 0.001), larger size of the lesion (mean 4.8 cm vs. 2.4 cm, P = 0.001), and presence of symptoms (44% vs. 16%, P = 0.001). Malignancy was present in 18% (32 of 170) of patients initially resected. Mucinous tumors (n = 18) were the most common malignant histologic subtype. None of the invasive cancers arising from mucinous cysts was <3 cm. Median radiographic follow-up in patients initially managed nonoperatively was 24 months (range, 1-172 months). In 29 patients (8%), changes developed within the cyst that resulted in resection; malignancy was present in 11 of 39 (38%), representing 3% (11 of 369) of all patients being followed radiographically. CONCLUSIONS: Selected patients with cystic lesions <3 cm in diameter and without a solid component may be followed radiographically with a malignancy risk (3% this study) that approximates the risk of mortality from resection. Malignancy within mucinous tumors is associated with size, and small mucinous tumors are very unlikely to be malignant. Copyright © 2006 by Lippincott Williams & Wilkins. |
| Keywords: | adult; human tissue; treatment outcome; aged; aged, 80 and over; middle aged; major clinical study; patient selection; pancreas cancer; treatment indication; computer assisted tomography; tumor volume; cystadenoma; pancreas cyst; surgical approach; cancer invasion; pancreas adenocarcinoma; pancreatectomy; symptomatology; pancreatic cyst |
| Journal Title: | Annals of Surgery |
| Volume: | 244 |
| Issue: | 4 |
| ISSN: | 0003-4932 |
| Publisher: | Lippincott Williams & Wilkins |
| Date Published: | 2006-10-01 |
| Start Page: | 572 |
| End Page: | 579 |
| Language: | English |
| DOI: | 10.1097/01.sla.0000237652.84466.54 |
| PUBMED: | 16998366 |
| PROVIDER: | scopus |
| PMCID: | PMC1856565 |
| DOI/URL: | |
| Notes: | --- - "Cited By (since 1996): 124" - "Export Date: 4 June 2012" - "CODEN: ANSUA" - "Source: Scopus" |
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