2008 Annual Meeting Abstracts
Current Trends in Pancreatic Cystic Neoplasms: Watch and Wait, or Resect?
Cristina R. Ferrone, MD1, Camilo Correa-Gallego, MD1, Andrew L. Warshaw1, William Brugge, MD2, David Forcione, MD2, Sarah P. Thayer, MD, PhD1, Carlos Fernandez-del-Castillo, MD1.
1Department of Surgery, Massachusetts General Hospital, Boston, MA, USA, 2Department of Gastroenterology, MGH, Boston, MA, USA.
Objective: To define how patients with pancreatic cysts are diagnosed and treated. Design: Retrospective case-series. Setting: University-affiliated tertiary care center. Patients: Four hundred-one patients evaluated in the department of surgery between January 2004 and December 2007. Main Outcome Measures: Clinical Management. Histological Diagnosis. Results of Surveillance. Results: Pancreatic cysts were incidentally discovered in 71% (286/403) of patients. There was no statistically significant difference in age (60.4 vs 63.1 years; p=0.1), cyst size (31 vs 27 mm; p=0.1) or histological diagnosis between symptomatic patients and patients with incidentally discovered cysts. Whereas the majority of symptomatic patients were resected, 49% (142/286) of incidentally discovered cysts were managed non-operatively. Of these, 14 (10%) patients underwent an operation after a median follow-up of 3 years. Reasons for resection included an increase in cyst size, development of symptoms, increasing tumor markers, worrisome EUS findings and patient anxiety. The two most prevalent diagnoses among all resected lesions were main duct IPMN (26%) and branch duct IPMN (22%). Malignancy was present in 28/255 (11%) of resected cysts, nine of which were incidentally discovered, and in 7% (1/14) of patients who underwent watchful waiting prior to resection. Conclusions: Incidentally discovered cysts comprise 71% of all cysts evaluated, of which 51% were resected. A change in diameter or development of symptoms prompted an operation in 10% of patients who were initially managed non-operatively. Invasive malignancy was present in 11% of all resections.