title: Cystic lesions of the pancreas: changes in the presentation and management of 1,424 patients at a single institution over a 15-year time period.
abstract: BACKGROUND
  Cystic lesions of the pancreas are being identified more frequently, and a selective approach to resection is now recommended. The aim of this study was to assess the change in presentation and management of pancreatic cystic lesions evaluated at a single institution over 15 years.
  
  
  METHODS
  A prospectively maintained registry of patients evaluated between 1995 and 2010 for the ICD-9 diagnosis of pancreatic cyst was reviewed. The 539 patients managed from 1995 to 2005 were compared with the 885 patients managed from 2005 to 2010.
  
  
  RESULTS
  A total of 1,424 patients were evaluated, including 1,141 with follow-up >6 months. Initial management (within 6 months of first assessment) was operative in 422 patients (37%) and nonoperative in 719 patients (63%). Operative mortality in patients initially submitted to resection was 0.7% (n = 3). Median radiographic follow-up in patients initially managed nonoperatively was 28 months (range 6 to 175 months). Patients followed radiographically were more likely to have cysts that were asymptomatic (72% versus 49%, p < 0.001), smaller (1.5 versus 3 cm, p < 0.001), without solid component (94% versus 68%, p < 0.001), and without main pancreatic duct dilation (88% versus 61%, p < 0.001). Changes prompting subsequent operative treatment occurred in 47 patients (6.5%), with adenocarcinoma identified in 8 (17%) and pancreatic endocrine neoplasm in 4 (8.5%). Thus, of the 719 patients initially managed nonoperatively, invasive malignancy was identified in 12 (1.7%), with adenocarcinoma seen in 1.1%.
  
  
  CONCLUSIONS
  Cystic lesions of the pancreas are being identified more frequently, yet are less likely to present with concerning features of malignancy. Carefully selected patients managed nonoperatively had a risk of malignancy that was equivalent to the risk of operative mortality in those patients who initially underwent resection.
authors.affiliation: Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA.
authors.forename: Sébastien
authors.initials: S
authors.lastname: Gaujoux
authors.forename: Murray F
authors.initials: MF
authors.lastname: Brennan
authors.forename: Mithat
authors.initials: M
authors.lastname: Gonen
authors.forename: Michael I
authors.initials: MI
authors.lastname: D'Angelica
authors.forename: Ronald
authors.initials: R
authors.lastname: DeMatteo
authors.forename: Yuman
authors.initials: Y
authors.lastname: Fong
authors.forename: Mark
authors.initials: M
authors.lastname: Schattner
authors.forename: Christopher
authors.initials: C
authors.lastname: DiMaio
authors.forename: Maria
authors.initials: M
authors.lastname: Janakos
authors.forename: William R
authors.initials: WR
authors.lastname: Jarnagin
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Allen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy; D010181:Pancreatic Cyst / Q000150:complications / Q000175:diagnosis* / Q000628:therapy*; D010190:Pancreatic Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000628:therapy*; D018579:Patient Selection; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult