Is there an indication for initial conservative management of pancreatic cystic lesions?
BACKGROUND
The management of small pancreatic cystic lesions presents a clinical challenge.


METHODS
We reviewed our experience with 78 patients who presented with a cystic pancreatic lesion who underwent operative management between 1995 and 2005. Data on cyst characteristics were analyzed in the context of pathologic findings following resection.


RESULTS
Among 78 patients, there were 55 (71%) females; median age 63 years. Patients presented with: an incidental finding (48%), pain (40%), acute pancreatitis (4%), other (8%). Operations were distal pancreatectomy (n = 47), pancreaticoduodenectomy (n = 16), and other (n = 15). Most patients had a non-malignant lesion (n = 65, 83%) (mucinous cystadenoma (n = 29), serous cystadenoma (n = 15), IPMN without invasion (n = 8), pseudocyst (n = 8), other benign (n = 5)). Malignant lesions (adenocarcinoma, neuroendocrine tumor, and other) were found in 13 patients (17%). The risk of malignancy increased with size: <3 cm (n = 25), 4%; 3-5 cm (n = 23), 13%; and >5 cm (n = 30), 30%. Pre-operative cyst fluid cytology was performed in 41 patients. The negative predictive value (NPV) of cytology for malignancy was 88% and the positive predictive value (PPV) was 80%. The NPV of CA 19-9 for malignancy was 90%; the PPV was 50%.


CONCLUSIONS
Initial conservative management of small cystic pancreatic lesions may be indicated in selected patients.
Grobmyer
Stephen R
SR
Division of Surgical Oncology, Department of Surgery, University of Florida College of Medicine, Gainesville, FL 32610, USA. stephen.grobmyer@surgery.ufl.edu
Cance
William G
WG
Copeland
Edward M
EM
Vogel
Stephen B
SB
Hochwald
Steven N
SN
D000230:Adenocarcinoma / Q000097:blood / Q000601:surgery; D018395:CA-19-9 Antigen / Q000097:blood; D002272:Carcinoembryonic Antigen / Q000032:analysis; D003537:Cystadenoma / Q000097:blood / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000209:etiology; D010180:Pancreatectomy; D010181:Pancreatic Cyst / Q000097:blood / Q000473:pathology* / Q000601:surgery*; D010190:Pancreatic Neoplasms / Q000097:blood / Q000601:surgery; D016577:Pancreaticoduodenectomy; D010195:Pancreatitis / Q000209:etiology; D011237:Predictive Value of Tests; D012189:Retrospective Studies
D018395:CA-19-9 Antigen; D002272:Carcinoembryonic Antigen