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Surgery. 2012 Sep;152(3 Suppl 1):S4-12. doi: 10.1016/j.surg.2012.05.033. Epub 2012 Jul 6.

851 resected cystic tumors of the pancreas: a 33-year experience at the Massachusetts General Hospital.

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1
General and GI Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.

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%.

CONCLUSION:

Cystic neoplasms of the pancreas are being diagnosed and treated with increasing frequency. At present, most are incidentally discovered intraductal papillary mucinous neoplasms.

PMID:
22770958
PMCID:
PMC3806101
DOI:
10.1016/j.surg.2012.05.033
[Indexed for MEDLINE]
Free PMC Article
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