Pancreatic pseudocysts: is delayed surgical intervention associated with adverse outcomes?
BACKGROUND
Nonsurgical interventions are increasingly applied for pancreatic pseudocysts. We hypothesized that surgical therapy applied after failure of percutaneous or endoscopic therapies for pseudocysts is associated with poorer outcomes than cases in which surgery is the initial intervention.


METHODS
Medical records of all 284 patients admitted with pancreatic pseudocysts at our institution (1/1990-9/2005) were analyzed. Forty-six patients underwent surgery as the initial intervention (group A). Among 162 patients who underwent percutaneous or endoscopic drainage as the initial intervention, 75 patients required subsequent surgery after failure of nonsurgical intervention (group B).


RESULTS
Groups were comparable in demographic variables and in location, number, and size of pseudocysts. Forty-two percent of group B patients developed infection within their pseudocysts after their nonsurgical interventions. Compared to group A patients, group B patients had higher rates of overall perioperative morbidity (47.8% vs 73.3%, p = 0.01) and postoperative readmission (24.0% vs 44.7%, p = 0.04). Five (6.7%) group B patients died in the perioperative period; there were no perioperative deaths among group A patients.


CONCLUSIONS
Delayed surgical intervention for pancreatic pseudocysts is associated with higher incidences of postoperative complications, readmission, morbidity, and mortality. The increasing application of nonsurgical interventions needs to be reevaluated.
Ito
Kaori
K
Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
Perez
Alexander
A
Ito
Hiromichi
H
Whang
Edward E
EE
D000208:Acute Disease; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010192:Pancreatic Pseudocyst / Q000150:complications / Q000601:surgery*; D010195:Pancreatitis / Q000209:etiology; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome