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Difficult Decisions in Hepatobiliary and Pancreatic Surgery pp 519–525Cite as

Surgery or Surveillance for Asymptomatic Small Mucinous Pancreatic Head Cyst

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Part of the book series: Difficult Decisions in Surgery: An Evidence-Based Approach ((DDSURGERY))

Abstract

Mucinous pancreatic cysts are now common incidental findings with the increased use and higher resolution of modern cross-sectional imaging, and surgeons are faced with the challenge of identifying those patients with premalignant or malignant lesions from those lesions with little chance of ever impacting patient survival. The risks of selecting to observe mucinous cystic lesions should be balanced against the morbidity and mortality of pancreatic resection, particularly when located in the head of the pancreas. Currently, the criteria for resection are based mainly on morphologic features or abnormal cytological findings. Most of the controversy revolves around the management of small branch-duct IPMN, given its relatively low malignant potential, high prevalence in older patients, and tendency to appear in the head of the gland. Thick/enhanced cyst wall, dilation of the pancreatic duct and mural nodules are consistent predictors of malignancy, while size alone remains controversial and a subject for continued debate.

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Author information

Authors and Affiliations

  1. Section of General Surgery, University of Chicago Medicine, Chicago, IL, USA

    J. Camilo Barreto

  2. Section of General Surgery and Surgical Oncology, University of Chicago Medicine, 5841 S. Maryland Ave Room G209, MC 5094, Chicago, IL, 60637, USA

    Mitchell C. Posner

Authors
  1. J. Camilo Barreto
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  2. Mitchell C. Posner
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Corresponding author

Correspondence to Mitchell C. Posner .

Editor information

Editors and Affiliations

  1. The University of Chicago, CHICAGO, Illinois, USA

    J. Michael Millis

  2. The University of Chicago, CHICAGO, Illinois, USA

    Jeffrey B. Matthews

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© 2016 Springer International Publishing Switzerland

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Barreto, J.C., Posner, M.C. (2016). Surgery or Surveillance for Asymptomatic Small Mucinous Pancreatic Head Cyst. In: Millis, J., Matthews, J. (eds) Difficult Decisions in Hepatobiliary and Pancreatic Surgery. Difficult Decisions in Surgery: An Evidence-Based Approach. Springer, Cham. https://doi.org/10.1007/978-3-319-27365-5_46

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  • DOI: https://doi.org/10.1007/978-3-319-27365-5_46

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-27363-1

  • Online ISBN: 978-3-319-27365-5

  • eBook Packages: MedicineMedicine (R0)

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