Predictive factors for surgery among patients with pancreatic cysts in the absence of high-risk features for malignancy.
BACKGROUND
Without a reliable biopsy technique for pancreatic cysts, consensus-based guidelines are used to guide surgical utilization. The primary objective of this study was to characterize the proportion of operations performed outside of these guidelines.


METHODS
A 5-year retrospective review between July 1, 2007, and June 30, 2012, was performed of consecutive patients seen at a single tertiary medical center for a pancreatic cyst. Manual chart review for relevant clinical variables and cyst characteristics was performed.


RESULTS
During this period, 148 patients underwent surgery, and of these, 23 (16 %) patients had no high-risk criteria by the 2006 Sendai criteria. None of these harbored high-grade dysplastic or cancerous lesions. A high cyst carcinoembryonic antigen (CEA) level (35 %), patient anxiety (26 %), and physician concern (22 %) were explicit reasons to proceed to surgery. An elevated cyst CEA level >192 ng/ml was the most significant predictor (OR 5.14 (95 % confidence interval (CI) 1.47-18.0) for surgery without high-risk criteria.


CONCLUSIONS
A high cyst CEA level was significantly associated with the decision to operate outside of consensus-based guidelines. The misuse of cyst CEA in the management of pancreatic cysts negatively impacts patient anxiety, increases physician uncertainty, and leads to surgery with minimal benefit.
Department of Medicine, Stanford University School of Medicine, Stanford, CA, 94305, USA.
Susan Y
SY
Quan
Brendan C
BC
Visser
George A
GA
Poultsides
Jeffrey A
JA
Norton
Ann M
AM
Chen
Subhas
S
Banerjee
Shai
S
Friedland
Walter G
WG
Park
D000368:Aged; D002272:Carcinoembryonic Antigen; D019160:Endosonography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy / Q000379:methods*; D010181:Pancreatic Cyst / Q000175:diagnosis / Q000601:surgery*; D010190:Pancreatic Neoplasms / Q000175:diagnosis; D011379:Prognosis; D012189:Retrospective Studies
D002272:Carcinoembryonic Antigen