BACKGROUND: The management of asymptomatic pancreatic cysts is controversial and indications for excision are based on pathology and natural history. OBJECTIVES: This study aimed to examine outcomes of asymptomatic lesions using a protocol based on size and cyst fluid analysis. METHODS: Asymptomatic cysts were identified from a prospectively maintained database. Sequential cross-sectional imaging studies were assessed, and results of endoscopic ultrasound-guided aspiration were co-analysed. RESULTS: A total of 338 asymptomatic patients underwent evaluation. Overall, 84 cysts were <1.5 cm and 254 were ≥1.5 cm in diameter. Median patient follow-up was 5.1 years [interquartile range (IQR): 4.1-6.9 years]. In the group in which cysts measured <1.5 cm in diameter, median cyst size was 1.0 cm (IQR: 0.6-1.2 cm) at presentation and increased to 1.2 cm (IQR: 0.7-1.6 cm) during follow-up. Five (6.0%) patients underwent resection, all within 2 months of presentation. In the group in which cysts measured ≥1.5 cm in diameter, median cyst size was 2.5 cm (IQR: 2.0-3.4 cm) at presentation and increased to 2.7 cm (IQR: 3.0-4.2 cm). A total of 63 (24.8%) patients underwent resection. Surgery was performed with 2 months in 53 (84.1%) patients, within 12 months in four (6.3%) patients and at >12 months post-presentation in six (9.5%) patients. A total of 70.6% of resected specimens were identified as malignancies or mucinous lesions. CONCLUSIONS: Asymptomatic cysts of <1.5 cm in diameter can safely be followed by imaging and are expected to undergo little change. A quarter of all asymptomatic cysts measuring ≥1.5 cm are appropriately resected based on imaging and cyst fluid analysis.
BACKGROUND: The management of asymptomatic pancreatic cysts is controversial and indications for excision are based on pathology and natural history. OBJECTIVES: This study aimed to examine outcomes of asymptomatic lesions using a protocol based on size and cyst fluid analysis. METHODS: Asymptomatic cysts were identified from a prospectively maintained database. Sequential cross-sectional imaging studies were assessed, and results of endoscopic ultrasound-guided aspiration were co-analysed. RESULTS: A total of 338 asymptomatic patients underwent evaluation. Overall, 84 cysts were <1.5 cm and 254 were ≥1.5 cm in diameter. Median patient follow-up was 5.1 years [interquartile range (IQR): 4.1-6.9 years]. In the group in which cysts measured <1.5 cm in diameter, median cyst size was 1.0 cm (IQR: 0.6-1.2 cm) at presentation and increased to 1.2 cm (IQR: 0.7-1.6 cm) during follow-up. Five (6.0%) patients underwent resection, all within 2 months of presentation. In the group in which cysts measured ≥1.5 cm in diameter, median cyst size was 2.5 cm (IQR: 2.0-3.4 cm) at presentation and increased to 2.7 cm (IQR: 3.0-4.2 cm). A total of 63 (24.8%) patients underwent resection. Surgery was performed with 2 months in 53 (84.1%) patients, within 12 months in four (6.3%) patients and at >12 months post-presentation in six (9.5%) patients. A total of 70.6% of resected specimens were identified as malignancies or mucinous lesions. CONCLUSIONS: Asymptomatic cysts of <1.5 cm in diameter can safely be followed by imaging and are expected to undergo little change. A quarter of all asymptomatic cysts measuring ≥1.5 cm are appropriately resected based on imaging and cyst fluid analysis.
Authors: Sang Hyub Lee; Cheol Min Shin; Joo Kyung Park; Sang Myung Woo; Ji Won Yoo; Ji Kon Ryu; Yong Bum Yoon; Yong-Tae Kim Journal: Dig Dis Sci Date: 2007-04-03 Impact factor: 3.199
Authors: R Matthew Walsh; David P Vogt; J Michael Henderson; Gregory Zuccaro; John Vargo; John Dumot; Brian Herts; Charles V Biscotti; Nancy Brown Journal: Surgery Date: 2005-10 Impact factor: 3.982
Authors: Sherry J Lim; Rameez Alasadi; Jeffrey D Wayne; Sam Rao; Alfred Rademaker; Richard Bell; Mark S Talamonti Journal: Surgery Date: 2005-10 Impact factor: 3.982
Authors: R Matthew Walsh; David P Vogt; J Michael Henderson; KenZo Hirose; Travis Mason; Kalman Bencsath; Jeffrey Hammel; Nancy Brown Journal: Surgery Date: 2008-08-29 Impact factor: 3.982
Authors: Taylor A Sohn; Charles J Yeo; John L Cameron; Ralph H Hruban; Noriyoshi Fukushima; Kurtis A Campbell; Keith D Lillemoe Journal: Ann Surg Date: 2004-06 Impact factor: 12.969
Authors: Bradley N Reames; Christopher P Scally; Timothy L Frankel; Justin B Dimick; Hari Nathan Journal: HPB (Oxford) Date: 2016-02-09 Impact factor: 3.647