Pancreatic pseudocysts following acute pancreatitis: risk factors influencing therapeutic outcomes.
BACKGROUND
The natural history of pancreatic pseudocysts has become well known in recent years, but the choice of a proper treatment still remains controversial.


OBJECTIVE
This study aims at establishing whether predictive factors influencing therapeutic outcomes exist.


METHODS
Patients with pancreatic pseudocysts following an episode of acute pancreatitis treated from January 1980 to December 2001 at the Department of General Surgery and Organ Transplantation of the University of Parma, Italy.


METHODS
Seventy-four patients were studied: 12 had a spontaneous resolution, 37 patients were treated surgically, 15 were treated endoscopically and in 10, percutaneous drainage was used.


METHODS
Epidemiological, clinical and pathological characteristics of patients with pancreatic pseudocysts were related to morbidity, recurrence rates and hospital stay.


RESULTS
At univariate logistic regression, our data reveal a significant increase in morbidity related to age (P=0.013), etiology (alcoholic vs. biliary, P=0.024), Ranson score of previous pancreatitis (P=0.006), nutritional assessment (P=0.001), residual necrosis (P<0.001) and modality of treatment (P=0.009), whereas none of these parameters has been shown to be significantly correlated to recurrence. At multivariate logistic regression, only residual necrosis was significantly related to morbidity.


CONCLUSIONS
Some factors, such as epidemiological (age, etiology), clinical (severity of previous pancreatitis, malnourishment), pathological (residual necrosis), and therapeutical factors (emergency/urgency treatment) are predictive of worse outcomes for invasive treatment of pseudocysts. In particular residual necrosis appeared to be the most important factor influencing invasive treatment outcomes, confirming that this pathological aspect deserves particular attention from surgeons. No risk factors predicting pancreatic pseudocyst recurrence emerged.
Soliani
Paolo
P
Department of General Surgery and Organ Transplantation, University of Parma, Parma, Italy. paolo.soliani@unipr.it
Franzini
Christian
C
Ziegler
Stefanie
S
Del Rio
Paolo
P
Dell'Abate
Paolo
P
Piccolo
Davide
D
Japichino
Gioacchino Giovanni
GG
Cavestro
Giulia Martina
GM
Di Mario
Francesco
F
Sianesi
Mario
M
D000208:Acute Disease; D000328:Adult; D000368:Aged; D013505:Digestive System Surgical Procedures / Q000379:methods / Q000401:mortality; D004322:Drainage / Q000379:methods / Q000401:mortality; D016099:Endoscopy, Gastrointestinal / Q000379:methods / Q000401:mortality; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D010179:Pancreas / Q000473:pathology / Q000601:surgery; D010192:Pancreatic Pseudocyst / Q000453:epidemiology*; D010195:Pancreatitis / Q000473:pathology* / Q000601:surgery; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome