Management of suspected pancreatic cystic neoplasms based on cyst size

R. Matthew Walsh, David P. Vogt, J. Michael Henderson, KenZo Hirose, Travis Mason, Kalman Bencsath, Jeffrey Hammel, Nancy Brown

Research output: Contribution to journalArticle

Abstract

Background: Evaluation and management of cystic pancreatic neoplasms remain problematic. International consensus guidelines have advised resection for lesions greater than 3 cm. Methods: We reviewed our prospective pancreatic cystic neoplasm database for outcomes based on a cyst size of 3 cm. Results: Five hundred patients have been managed from 1999 to 2006. There were 349 patients (70%) with cysts less than or equal to 3 cm: 293 (84%) were not operated, including 243 nonmucinous cysts: 2 failed observation (0.8%, mean follow-up of 24 months). Fifty-six patients with cysts less than or equal to 3 cm were initially operated (16%), including 23 asymptomatic patients. Histopathology showed intraductal papillary mucinous neoplasm (IPMN) in 20, mucinous cystic neoplasm (MCN) in 18, and serous cystadenoma in 5. Twelve had carcinoma (21%). A total of 151 patients (30%) had cysts greater than cm: 87 (50%) were not operated, including 68 that were nonmucinous: 2 failed observation (2.9%, mean follow-up of 47 months). Sixty-four patients with cysts greater than 3 cm (42%) were initially operated, and final pathology showed MCN in 27, serous cystadenoma in 11, IPMN in 7, and pseudocyst in 7. Twelve had carcinoma (19%). Patients with cysts less than or equal to 3 cm were less likely to be operated (16 vs 42%; P <.001), less often symptomatic (39 vs 50%; P = .017), while older (mean age, 65 vs 61 years; P = .03). Had patients been managed by size alone, up to 20% would have received inappropriate treatment. Management based on aspiration was significantly better in predicting mucinous neoplasms compared with size (75% vs 57%; P <.001), including asymptomatic patients less than or equal to 3 cm (78% vs 65%; P = .003). Conclusion: Size of pancreatic cystic lesions alone is not a reasonable basis for determining management.

Original languageEnglish (US)
Pages (from-to)677-685
Number of pages9
JournalSurgery
Volume144
Issue number4
DOIs
StatePublished - Oct 2008
Externally publishedYes

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Pancreatic Neoplasms
Cysts
Serous Cystadenoma
Neoplasms
Observation
Carcinoma
Databases
Guidelines
Pathology

ASJC Scopus subject areas

  • Surgery

Cite this

Walsh, R. M., Vogt, D. P., Henderson, J. M., Hirose, K., Mason, T., Bencsath, K., ... Brown, N. (2008). Management of suspected pancreatic cystic neoplasms based on cyst size. Surgery, 144(4), 677-685. https://doi.org/10.1016/j.surg.2008.06.013

Management of suspected pancreatic cystic neoplasms based on cyst size. / Walsh, R. Matthew; Vogt, David P.; Henderson, J. Michael; Hirose, KenZo; Mason, Travis; Bencsath, Kalman; Hammel, Jeffrey; Brown, Nancy.

In: Surgery, Vol. 144, No. 4, 10.2008, p. 677-685.

Research output: Contribution to journalArticle

Walsh, RM, Vogt, DP, Henderson, JM, Hirose, K, Mason, T, Bencsath, K, Hammel, J & Brown, N 2008, 'Management of suspected pancreatic cystic neoplasms based on cyst size', Surgery, vol. 144, no. 4, pp. 677-685. https://doi.org/10.1016/j.surg.2008.06.013
Walsh RM, Vogt DP, Henderson JM, Hirose K, Mason T, Bencsath K et al. Management of suspected pancreatic cystic neoplasms based on cyst size. Surgery. 2008 Oct;144(4):677-685. https://doi.org/10.1016/j.surg.2008.06.013
Walsh, R. Matthew ; Vogt, David P. ; Henderson, J. Michael ; Hirose, KenZo ; Mason, Travis ; Bencsath, Kalman ; Hammel, Jeffrey ; Brown, Nancy. / Management of suspected pancreatic cystic neoplasms based on cyst size. In: Surgery. 2008 ; Vol. 144, No. 4. pp. 677-685.
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title = "Management of suspected pancreatic cystic neoplasms based on cyst size",
abstract = "Background: Evaluation and management of cystic pancreatic neoplasms remain problematic. International consensus guidelines have advised resection for lesions greater than 3 cm. Methods: We reviewed our prospective pancreatic cystic neoplasm database for outcomes based on a cyst size of 3 cm. Results: Five hundred patients have been managed from 1999 to 2006. There were 349 patients (70{\%}) with cysts less than or equal to 3 cm: 293 (84{\%}) were not operated, including 243 nonmucinous cysts: 2 failed observation (0.8{\%}, mean follow-up of 24 months). Fifty-six patients with cysts less than or equal to 3 cm were initially operated (16{\%}), including 23 asymptomatic patients. Histopathology showed intraductal papillary mucinous neoplasm (IPMN) in 20, mucinous cystic neoplasm (MCN) in 18, and serous cystadenoma in 5. Twelve had carcinoma (21{\%}). A total of 151 patients (30{\%}) had cysts greater than cm: 87 (50{\%}) were not operated, including 68 that were nonmucinous: 2 failed observation (2.9{\%}, mean follow-up of 47 months). Sixty-four patients with cysts greater than 3 cm (42{\%}) were initially operated, and final pathology showed MCN in 27, serous cystadenoma in 11, IPMN in 7, and pseudocyst in 7. Twelve had carcinoma (19{\%}). Patients with cysts less than or equal to 3 cm were less likely to be operated (16 vs 42{\%}; P <.001), less often symptomatic (39 vs 50{\%}; P = .017), while older (mean age, 65 vs 61 years; P = .03). Had patients been managed by size alone, up to 20{\%} would have received inappropriate treatment. Management based on aspiration was significantly better in predicting mucinous neoplasms compared with size (75{\%} vs 57{\%}; P <.001), including asymptomatic patients less than or equal to 3 cm (78{\%} vs 65{\%}; P = .003). Conclusion: Size of pancreatic cystic lesions alone is not a reasonable basis for determining management.",
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AU - Walsh, R. Matthew

AU - Vogt, David P.

AU - Henderson, J. Michael

AU - Hirose, KenZo

AU - Mason, Travis

AU - Bencsath, Kalman

AU - Hammel, Jeffrey

AU - Brown, Nancy

PY - 2008/10

Y1 - 2008/10

N2 - Background: Evaluation and management of cystic pancreatic neoplasms remain problematic. International consensus guidelines have advised resection for lesions greater than 3 cm. Methods: We reviewed our prospective pancreatic cystic neoplasm database for outcomes based on a cyst size of 3 cm. Results: Five hundred patients have been managed from 1999 to 2006. There were 349 patients (70%) with cysts less than or equal to 3 cm: 293 (84%) were not operated, including 243 nonmucinous cysts: 2 failed observation (0.8%, mean follow-up of 24 months). Fifty-six patients with cysts less than or equal to 3 cm were initially operated (16%), including 23 asymptomatic patients. Histopathology showed intraductal papillary mucinous neoplasm (IPMN) in 20, mucinous cystic neoplasm (MCN) in 18, and serous cystadenoma in 5. Twelve had carcinoma (21%). A total of 151 patients (30%) had cysts greater than cm: 87 (50%) were not operated, including 68 that were nonmucinous: 2 failed observation (2.9%, mean follow-up of 47 months). Sixty-four patients with cysts greater than 3 cm (42%) were initially operated, and final pathology showed MCN in 27, serous cystadenoma in 11, IPMN in 7, and pseudocyst in 7. Twelve had carcinoma (19%). Patients with cysts less than or equal to 3 cm were less likely to be operated (16 vs 42%; P <.001), less often symptomatic (39 vs 50%; P = .017), while older (mean age, 65 vs 61 years; P = .03). Had patients been managed by size alone, up to 20% would have received inappropriate treatment. Management based on aspiration was significantly better in predicting mucinous neoplasms compared with size (75% vs 57%; P <.001), including asymptomatic patients less than or equal to 3 cm (78% vs 65%; P = .003). Conclusion: Size of pancreatic cystic lesions alone is not a reasonable basis for determining management.

AB - Background: Evaluation and management of cystic pancreatic neoplasms remain problematic. International consensus guidelines have advised resection for lesions greater than 3 cm. Methods: We reviewed our prospective pancreatic cystic neoplasm database for outcomes based on a cyst size of 3 cm. Results: Five hundred patients have been managed from 1999 to 2006. There were 349 patients (70%) with cysts less than or equal to 3 cm: 293 (84%) were not operated, including 243 nonmucinous cysts: 2 failed observation (0.8%, mean follow-up of 24 months). Fifty-six patients with cysts less than or equal to 3 cm were initially operated (16%), including 23 asymptomatic patients. Histopathology showed intraductal papillary mucinous neoplasm (IPMN) in 20, mucinous cystic neoplasm (MCN) in 18, and serous cystadenoma in 5. Twelve had carcinoma (21%). A total of 151 patients (30%) had cysts greater than cm: 87 (50%) were not operated, including 68 that were nonmucinous: 2 failed observation (2.9%, mean follow-up of 47 months). Sixty-four patients with cysts greater than 3 cm (42%) were initially operated, and final pathology showed MCN in 27, serous cystadenoma in 11, IPMN in 7, and pseudocyst in 7. Twelve had carcinoma (19%). Patients with cysts less than or equal to 3 cm were less likely to be operated (16 vs 42%; P <.001), less often symptomatic (39 vs 50%; P = .017), while older (mean age, 65 vs 61 years; P = .03). Had patients been managed by size alone, up to 20% would have received inappropriate treatment. Management based on aspiration was significantly better in predicting mucinous neoplasms compared with size (75% vs 57%; P <.001), including asymptomatic patients less than or equal to 3 cm (78% vs 65%; P = .003). Conclusion: Size of pancreatic cystic lesions alone is not a reasonable basis for determining management.

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