title: Pancreatic cysts: a proposed management algorithm based on current evidence.
abstract: BACKGROUND
  Currently, the management strategy of pancreatic cyst (PC) remains controversial because of the inability to diagnose this type of cyst accurately and the limited knowledge of its natural history. Previously, many clinicians have advocated an aggressive resectional policy. This approach is no longer appropriate, and the number of PCs detected incidentally has increased. This study reviews the present literature and attempts to provide a management algorithm of pancreatic cysts based on currently available evidence.
  
  
  METHODS
  A Medline search was conducted to identify studies investigating PC, with particular emphasis placed on studies addressing its diagnosis and management. Additional articles were obtained from the reference lists of key articles and recent reviews.
  
  
  CONCLUSIONS
  Based on current evidence, the optimal management of PC remains an art and should be individualized based on the risk-benefit ratio of surgery, which is influenced by multiple factors, such as the patient's potential life expectancy, surgical risk; and malignant potential of the cyst. Our proposed management algorithm is based on an individual's predicted risk-benefit ratio of surgery. Prospective evaluation of the algorithm is needed to determine its integrity.
authors.affiliation: Department of Surgery, Singapore General Hospital, Outram Road, Singapore 169608. bsgkp@hotmail.com
authors.forename: Brian K P
authors.initials: BK
authors.lastname: Goh
authors.forename: Yu-Meng
authors.initials: YM
authors.lastname: Tan
authors.forename: Yaw-Fui Alexander
authors.initials: YF
authors.lastname: Chung
authors.forename: Pierce K H
authors.initials: PK
authors.lastname: Chow
authors.forename: Peng-Chung
authors.initials: PC
authors.lastname: Cheow
authors.forename: Choon-Hua
authors.initials: CH
authors.lastname: Thng
authors.forename: Steven
authors.initials: S
authors.lastname: Mesenas
authors.forename: Wai-Keong
authors.initials: WK
authors.lastname: Wong
authors.forename: London L P J
authors.initials: LL
authors.lastname: Ooi
mesh_terms: D000465:Algorithms; D044963:Biopsy, Fine-Needle; D003937:Diagnosis, Differential; D018450:Disease Progression; D019160:Endosonography; D006801:Humans; D010180:Pancreatectomy / Q000379:methods*; D010181:Pancreatic Cyst / Q000175:diagnosis* / Q000601:surgery*; D010190:Pancreatic Neoplasms / Q000175:diagnosis; D011379:Prognosis; D012307:Risk Factors; D014057:Tomography, X-Ray Computed