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Cystic lesions of the pancreas: selection criteria for operative and nonoperative management in 209 patients

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Abstract

Because of the inability to determine benign from malignant, many have recommended that all cystic lesions of the pancreas be resected. Patients evaluated between January 1995 and December 2000 for the ICD-9 diagnosis of pancreatic cyst (577.2) or benign neoplasm of the pancreas (211.6) were reviewed. Patient, cyst, and treatment characteristics were recorded. Comparisons were made between patients who underwent operative and nonoperative management. Over the 5-year period, 209 patients were evaluated. Nonoperative treatment was initially chosen for 144 patients (69%). In this group the average cyst diameter was 2.5 cm (range 0.5 cm to 13.0 cm), and the median change in diameter during follow-up was zero cm (range 1.5 cm to 4.0 cm). In six patients (4%) changes occurred within the cyst that resulted in resection. None of these patients had a malignant diagnosis. Operative treatment was initially chosen for 65 (31%) of the 209 patients. Malignancy was found in six of the operative patients (6 [9%] of 65). Differences in patient and cyst characteristics between groups included the cyst size, septations, a solid component, and the presence of symptoms. Selected patients with cystic lesions of the pancreas may be safely followed radiographically. Selection criteria identified in this study (symptoms, cyst size, solid component, and septations) and the utilization of new imaging techniques allow the creation of treatment plans for these patients that can be prospectively tested.

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References

  1. Kloppel G, Solcia E, Longnecker D. Histological typing of tumors of the exocrine pancreas, 2nd ed. Berlin: Springer, 1996.

    Google Scholar 

  2. Walsh RM, Henderson JM, Vogt DP, et al. Prospective preoperative determination of mucinous pancreatic cystic neoplasms. Surgery 2002;132:628–633.

    Article  PubMed  Google Scholar 

  3. Fernandez-del Castillo C, Warshaw AL. Cystic tumors of the pancreas. Surg Clin North Am 1995;75:1001–1016.

    Google Scholar 

  4. Siech M, Tripp K, Schmidt-Rohlfing B, et al. Cystic tumours of the pancreas: Diagnostic accuracy, pathologic observations and surgical consequences. Langenbecks Arch Surg 1998; 383:56–61.

    Article  PubMed  CAS  Google Scholar 

  5. Ooi LL, Ho GH, Chew SP, Low CH, Soo KC. Cystic tumours of the pancreas: A diagnostic dilemma. Aust N Z J Surg 1998;68:844–846.

    Article  PubMed  CAS  Google Scholar 

  6. Gorin AD, Sackier JM. Incidental detection of cystic neoplasms of the pancreas. Md Med J 1997;46:79–82.

    PubMed  CAS  Google Scholar 

  7. Fernandez-del Castillo C, Warshaw AL. Current management of cystic neoplasms of the pancreas. Adv Surg 2000; 34:237–248.

    Google Scholar 

  8. Compagno J, Oertel JE. Microcystic adenomas of the pancreas (glycogen-rich cystadenomas): A clinicopathologic study of 34 cases. Am J Clin Pathol 1978;69:289–298.

    PubMed  CAS  Google Scholar 

  9. Compagno J, Oertel JE. Mucinous cystic neoplasms of the pancreas with overt and latent malignancy (cystadenocarcinoma and cystadenoma). A clinicopathologic study of 41 cases. Am J Clin Pathol 1978;69:573–580.

    PubMed  CAS  Google Scholar 

  10. Le Borgne J, De Calan L, Partensky C. Cystadenomas and cystadenocarcinomas of the pancreas: A multi-institutional retrospective study of 398 cases. French Surgical Association. Ann Surg 1999;230:152–161.

    Article  PubMed  Google Scholar 

  11. Johnson CD, Stephens DH, CharboneauJW, Carpenter HA, Welch TJ. Cystic pancreatic tumors: CT and sonographic assessment. AJR AmJ Roentgenol 1988;151:1133–1138.

    CAS  Google Scholar 

  12. Becker WF, Welsh RA, Pratt HS. Cystadenoma and cystadenocarcinoma of the pancreas. Ann Surg 1965;161:845–863.

    Article  PubMed  CAS  Google Scholar 

  13. Warshaw AL, Rutledge PL. Cystic tumors mistaken for pancreatic pseudocysts. Ann Surg 1987;205:393–398.

    Article  PubMed  CAS  Google Scholar 

  14. Sarr MG, Murr M, Smyrk TC, Yeo CJ, Fernandez-del- Castillo C, Hawes RH, Freeny PC. Primary cystic neoplasms of the pancreas: Neoplastic disorders of emerging importance—Current state-of-the-art and unanswered questions. J Gastrointest Surg 2003;7:417–428.

    Article  PubMed  Google Scholar 

  15. Hashimoto L, Walsh RM, Vogt D, Henderson JM, Mayes J, Hermann R. Presentation and management of cystic neoplasms of the pancreas. J Gastrointest Surg 1998;2:504–508.

    Article  CAS  Google Scholar 

  16. Pyke CM, van Heerden JA, Colby TV, Sarr MG, Weaver AL. The spectrum of serous cystadenoma of the pancreas. Clinical, pathologic, and surgical aspects. Ann Surg 1992;215:132–139.

    Article  PubMed  CAS  Google Scholar 

  17. Sperti C, Pasquali C, Chierichetti F, Liessi G, Ferlin G, Pedrazzoli S. Value of 18-fluorodeoxyglucose positron emission tomography in the management of patients with cystic tumors of the pancreas. Ann Surg 2001;234(675):680.

    Google Scholar 

  18. Warren KW, Hardy KJ. Cystadenocarcinoma of the pancreas. Surg Gynecol Obstet 1968;127:734–736.

    PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Memorial Sloan-Kettering Cancer Center, New York, New York

    Peter J. Allen M.D., David P. Jaques M.D., Michael D’Angelica M.D., Wilbur B. Bowne M.D., Kevin C. Conlon M.D. & Murray F. Brennan M.D.

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  1. Peter J. Allen M.D.
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  2. David P. Jaques M.D.
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  3. Michael D’Angelica M.D.
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  4. Wilbur B. Bowne M.D.
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  5. Kevin C. Conlon M.D.
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  6. Murray F. Brennan M.D.
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Correspondence to Murray F. Brennan M.D..

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Allen, P.J., Jaques, D.P., D’Angelica, M. et al. Cystic lesions of the pancreas: selection criteria for operative and nonoperative management in 209 patients. J Gastrointest Surg 7, 970–977 (2003). https://doi.org/10.1016/j.gassur.2003.08.008

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  • DOI: https://doi.org/10.1016/j.gassur.2003.08.008

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