title: 851 resected cystic tumors of the pancreas: a 33-year experience at the Massachusetts General Hospital.
abstract: BACKGROUND
  The objective of this study was to identify trends in the diagnosis and treatment of cystic neoplasms of the pancreas using a retrospective review of patients from a surgical database at an academic referral center during a 33-year period.
  
  
  METHODS
  Patient characteristics, including demographics, pathology, and survival, were analyzed over 5 time periods between 1978 and 2011.
  
  
  RESULTS
  A total of 851 consecutive patients underwent resection for a cystic neoplasm of the pancreas during a 33-year period. Sixty-five percent of patients were female, and mean age was 60 years. The most common pathologic diagnoses were intraductal papillary mucinous neoplasm (38%), mucinous cystic neoplasm (23%), serous cystadenoma (16%), and cystic neuroendocrine neoplasm (7%). There was a stepwise increase in the number of resections across time periods (67 between 1978 and 1989; 376 between 2005 and 2011), with a parallel increase in the proportion of incidentally discovered lesions (22% to 50%). Diagnosis of intraductal papillary mucinous neoplasm was very uncommon in the first 2 time periods (before the first recognition of intraductal papillary mucinous neoplasm as a distinct entity) but predominated in the last 2 (41% and 49%), and cystic neuroendocrine neoplasms, which constituted 3% of the cystic neoplasms in the first time-period, now comprise more than 8% of pancreatic cystic neoplasms. The proportion of malignant neoplasms decreased over time (41% between 1978 and 1989; 12% between 2005 and 2011), reflecting probably the earlier diagnosis and treatment of premalignant neoplasms. Although operative mortality was minimal (4/849, 0.5%), the postoperative complication rate was 38%. Overall 5-year survival for all mucinous lesions was 87%.
  
  
  CONCLUSIONS
  Cystic neoplasms of the pancreas are being diagnosed and treated with increasing frequency. At present, most are incidentally discovered intraductal papillary mucinous neoplasms.
authors: General and GI Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
authors: Nakul P
authors: NP
authors: Valsangkar
authors: Vicente
authors: V
authors: Morales-Oyarvide
authors: Sarah P
authors: SP
authors: Thayer
authors: Cristina R
authors: CR
authors: Ferrone
authors: Jennifer A
authors: JA
authors: Wargo
authors: Andrew L
authors: AL
authors: Warshaw
authors: Carlos
authors: C
authors: Fernández-del Castillo
mesh_terms: D000328:Adult; D018291:Cystadenoma, Mucinous / Q000601:surgery; D018293:Cystadenoma, Serous / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018358:Neuroendocrine Tumors / Q000601:surgery; D010180:Pancreatectomy / Q000009:adverse effects / Q000401:mortality; D010190:Pancreatic Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects / Q000401:mortality; D011183:Postoperative Complications; D015996:Survival Rate