Skip to main content
SpringerLink
Log in

Predictive Factors for Surgery Among Patients with Pancreatic Cysts in the Absence of High-Risk Features for Malignancy

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Without a reliable biopsy technique for pancreatic cysts, consensus-based guidelines are used to guide surgical utilization. The primary objective of this study was to characterize the proportion of operations performed outside of these guidelines.

Methods

A 5-year retrospective review between July 1, 2007, and June 30, 2012, was performed of consecutive patients seen at a single tertiary medical center for a pancreatic cyst. Manual chart review for relevant clinical variables and cyst characteristics was performed.

Results

During this period, 148 patients underwent surgery, and of these, 23 (16 %) patients had no high-risk criteria by the 2006 Sendai criteria. None of these harbored high-grade dysplastic or cancerous lesions. A high cyst carcinoembryonic antigen (CEA) level (35 %), patient anxiety (26 %), and physician concern (22 %) were explicit reasons to proceed to surgery. An elevated cyst CEA level >192 ng/ml was the most significant predictor (OR 5.14 (95 % confidence interval (CI) 1.47–18.0) for surgery without high-risk criteria.

Conclusion

A high cyst CEA level was significantly associated with the decision to operate outside of consensus-based guidelines. The misuse of cyst CEA in the management of pancreatic cysts negatively impacts patient anxiety, increases physician uncertainty, and leads to surgery with minimal benefit.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Adsay NV. Cystic Lesions of the Pancreas. Mod Pathol 2007;20 Suppl 1:S71-93.

    Article  Google Scholar 

  2. Tanaka M, Chari S, Adsay V, et al. International consensus guidelines for management of intraductal papillary mucinous neoplasms and mucinous cystic neoplasms of the pancreas. Pancreatology 2006;6:17-32.

    Article  PubMed  Google Scholar 

  3. Tanaka M, Fernandez-Del Castillo C, Adsay V, et al. International consensus guidelines 2012 for the management of IPMN and MCN of the pancreas. Pancreatology 2012;12:183-97.

    Article  PubMed  Google Scholar 

  4. Correa-Gallego C, Ferrone CR, Thayer SP, et al. Incidental pancreatic cysts: do we really know what we are watching? Pancreatology 2010;10:144-50.

    Article  PubMed Central  PubMed  Google Scholar 

  5. Laffan TA, Horton KM, Klein AP, et al. Prevalence of unsuspected pancreatic cysts on MDCT. AJR Am J Roentgenol 2008;191:802-7.

    Article  PubMed Central  PubMed  Google Scholar 

  6. de Jong K, Nio CY, Hermans JJ, et al. High prevalence of pancreatic cysts detected by screening magnetic resonance imaging examinations. Clin Gastroenterol Hepatol 2010;8:806-11.

    Article  PubMed  Google Scholar 

  7. Brugge WR, Lewandrowski K, Lee-Lewandrowski E, et al. Diagnosis of pancreatic cystic neoplasms: a report of the cooperative pancreatic cyst study. Gastroenterology 2004;126:1330-6.

    Article  PubMed  Google Scholar 

  8. van der Waaij LA, van Dullemen HM, Porte RJ. Cyst fluid analysis in the differential diagnosis of pancreatic cystic lesions: a pooled analysis. Gastrointest Endosc 2005;62:383-9.

    Article  PubMed  Google Scholar 

  9. Park WG, Mascarenhas R, Palaez-Luna M, et al. Diagnostic performance of cyst fluid carcinoembryonic antigen and amylase in histologically confirmed pancreatic cysts. Pancreas 2011;40:42-5.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  10. Morris-Stiff G, Lentz G, Chalikonda S, et al. Pancreatic cyst aspiration analysis for cystic neoplasms: mucin or carcinoembryonic antigen—which is better? Surgery 2010;148:638-44; discussion 644-5.

    Article  PubMed  Google Scholar 

  11. Khalid A, Zahid M, Finkelstein SD, et al. Pancreatic cyst fluid DNA analysis in evaluating pancreatic cysts: a report of the PANDA study. Gastrointest Endosc 2009;69:1095-102.

    Article  PubMed  Google Scholar 

  12. Cizginer S, Turner BG, Bilge AR, et al. Cyst fluid carcinoembryonic antigen is an accurate diagnostic marker of pancreatic mucinous cysts. Pancreas 2011;40:1024-8.

    Article  CAS  PubMed  Google Scholar 

  13. Buscaglia JM, Giday SA, Kantsevoy SV, et al. Patient- and cyst-related factors for improved prediction of malignancy within cystic lesions of the pancreas. Pancreatology 2009;9:631-8.

    Article  PubMed  Google Scholar 

  14. Khalid A, Brugge W. ACG practice guidelines for the diagnosis and management of neoplastic pancreatic cysts. Am J Gastroenterol 2007;102:2339-49.

    Article  PubMed  Google Scholar 

Download references

Acknowledgment

W.G. Park is supported by the American College of Gastroenterology Junior Faculty Development Award.

Author information

Authors and Affiliations

  1. Department of Medicine, Stanford University School of Medicine, Stanford, CA, 94305, USA

    Susan Y. Quan, Ann M. Chen, Subhas Banerjee, Shai Friedland & Walter G. Park

  2. Department of Surgery, Stanford University School of Medicine, Stanford, CA, 94305, USA

    Brendan C. Visser, George A. Poultsides & Jeffrey A. Norton

  3. Pancreas Clinic, Stanford University School of Medicine, 300 Pasteur Drive, MC: 5187, Stanford, CA, 94305, USA

    Walter G. Park

Authors
  1. Susan Y. Quan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Brendan C. Visser
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. George A. Poultsides
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jeffrey A. Norton
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ann M. Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Subhas Banerjee
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Shai Friedland
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Walter G. Park
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Walter G. Park.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Quan, S.Y., Visser, B.C., Poultsides, G.A. et al. Predictive Factors for Surgery Among Patients with Pancreatic Cysts in the Absence of High-Risk Features for Malignancy. J Gastrointest Surg 19, 1101–1105 (2015). https://doi.org/10.1007/s11605-015-2786-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11605-015-2786-3

Keywords

Search

Navigation