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A selective approach to the resection of cystic lesions of the pancreas: results from 539 consecutive patients.

Publication ,  Journal Article
Allen, PJ; D'Angelica, M; Gonen, M; Jaques, DP; Coit, DG; Jarnagin, WR; DeMatteo, R; Fong, Y; Blumgart, LH; Brennan, MF
Published in: Ann Surg
October 2006

OBJECTIVE: To define a group of patients with pancreatic cysts who do not require resection. SUMMARY BACKGROUND DATA: The increased use of cross-sectional imaging has resulted in an increased identification of small, asymptomatic pancreatic cysts. Data have not been available to determine which lesions should be resected. METHODS: All patients evaluated at our institution between January 1995 and January 2005 for the ICD-9 diagnosis of pancreatic cyst were reviewed. Analysis was performed to identify associations between patient and cyst characteristics, and selection of operative or nonoperative management. RESULTS: Pancreatic cysts were evaluated in 539 patients. Initial management was operative in 170 patients (32%), and nonoperative (radiographic follow-up) in 369 patients (68%). Factors associated with initial operative management included presence of a solid component (45% vs. 6%, P < 0.001), larger size of the lesion (mean 4.8 cm vs. 2.4 cm, P = 0.001), and presence of symptoms (44% vs. 16%, P = 0.001). Malignancy was present in 18% (32 of 170) of patients initially resected. Mucinous tumors (n = 18) were the most common malignant histologic subtype. None of the invasive cancers arising from mucinous cysts was <3 cm. Median radiographic follow-up in patients initially managed nonoperatively was 24 months (range, 1-172 months). In 29 patients (8%), changes developed within the cyst that resulted in resection; malignancy was present in 11 of 39 (38%), representing 3% (11 of 369) of all patients being followed radiographically. CONCLUSIONS: Selected patients with cystic lesions <3 cm in diameter and without a solid component may be followed radiographically with a malignancy risk (3% this study) that approximates the risk of mortality from resection. Malignancy within mucinous tumors is associated with size, and small mucinous tumors are very unlikely to be malignant.

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Published In

Ann Surg

DOI

ISSN

0003-4932

Publication Date

October 2006

Volume

244

Issue

4

Start / End Page

572 / 582

Location

United States

Related Subject Headings

  • Surgery
  • Patient Selection
  • Pancreatic Cyst
  • Pancreatectomy
  • Middle Aged
  • Male
  • Humans
  • Female
  • Aged, 80 and over
  • Aged
 

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Allen, P. J., D’Angelica, M., Gonen, M., Jaques, D. P., Coit, D. G., Jarnagin, W. R., … Brennan, M. F. (2006). A selective approach to the resection of cystic lesions of the pancreas: results from 539 consecutive patients. Ann Surg, 244(4), 572–582. https://doi.org/10.1097/01.sla.0000237652.84466.54
Allen, Peter J., Michael D’Angelica, Mithat Gonen, David P. Jaques, Daniel G. Coit, William R. Jarnagin, Ronald DeMatteo, Yuman Fong, Leslie H. Blumgart, and Murray F. Brennan. “A selective approach to the resection of cystic lesions of the pancreas: results from 539 consecutive patients.Ann Surg 244, no. 4 (October 2006): 572–82. https://doi.org/10.1097/01.sla.0000237652.84466.54.
Allen PJ, D’Angelica M, Gonen M, Jaques DP, Coit DG, Jarnagin WR, et al. A selective approach to the resection of cystic lesions of the pancreas: results from 539 consecutive patients. Ann Surg. 2006 Oct;244(4):572–82.
Allen, Peter J., et al. “A selective approach to the resection of cystic lesions of the pancreas: results from 539 consecutive patients.Ann Surg, vol. 244, no. 4, Oct. 2006, pp. 572–82. Pubmed, doi:10.1097/01.sla.0000237652.84466.54.
Allen PJ, D’Angelica M, Gonen M, Jaques DP, Coit DG, Jarnagin WR, DeMatteo R, Fong Y, Blumgart LH, Brennan MF. A selective approach to the resection of cystic lesions of the pancreas: results from 539 consecutive patients. Ann Surg. 2006 Oct;244(4):572–582.

Published In

Ann Surg

DOI

ISSN

0003-4932

Publication Date

October 2006

Volume

244

Issue

4

Start / End Page

572 / 582

Location

United States

Related Subject Headings

  • Surgery
  • Patient Selection
  • Pancreatic Cyst
  • Pancreatectomy
  • Middle Aged
  • Male
  • Humans
  • Female
  • Aged, 80 and over
  • Aged