A Selective Approach to Resection in Patients with Cystic Lesions of the Pancreas: Results from 539 Consecutive Patients
Peter J. Allen, M.D.*, Michael D'Angelica, M.D.*, David P. Jaques, M.D., Daniel G. Coit, M.D., William R. Jarnagin, M.D.*, Ronald P. DeMatteo, M.D.*, Yuman Fong, M.D., Leslie H. Blumgart, M.D., Murray F. Brennan, M.D.
Memorial Sloan-Kettering Cancer Center, New York, NY
OBJECTIVE(S): Increased use of high-quality cross-sectional imaging has resulted in increased identification of small, asymptomatic pancreatic cysts. Data is not available to determine which lesions should be resected.
METHODS: Patients evaluated between Jan.1995 and Jan.2005 for the ICD-9 diagnosis of pancreatic cyst were reviewed. Patient, cyst, and management characteristics were recorded. Analyses were performed to identify associations between patient, and cyst characteristics, and selection of operative and non-operative management.
RESULTS: Pancreatic cysts were evaluated in 539 patients. Initial management was operative in 169 patients (31%), and non-operative in 370 patients (69%). Factors associated with operative management included increased cyst diameter (mean 4.8cm. vs. 2.4cm, p=0.001), presence of solid component (45% vs. 6%, p<0.001), and presence of symptoms (44% vs. 16%, p=0.001). Malignancy was present in 19% (32/169) of patients initially resected. Mucinous tumors (papillary mucinous carcinoma,n=12; mucinous cystadenocarcinoma,n=6) were the most common malignant sub-types. All patients with invasive mucinous tumors had lesions >3cm in diameter (see figure). Median radiographic follow-up for patients initially managed non-operatively was 24 months. Radiographic changes prompting subsequent resection occurred in 30 patients (8%) . Malignancy was present in eight of these patients (8/30, 27%), and represents 2% of patients (8/340) being followed radiographically.
CONCLUSIONS: Selected patients with cystic lesions <3cm in diameter and without a solid component may be followed with a malignancy risk (2% this study) that approximates the risk of mortality from resection. Malignancy within mucinous cysts is associated with size, and small mucinous tumors may be followed safely in selected patients.
Back to Scientific Program