Back to Search
Start Over
Comparing 3 guidelines on the management of surgically removed pancreatic cysts with regard to pathological outcome.
- Source :
-
Gastrointestinal endoscopy [Gastrointest Endosc] 2017 May; Vol. 85 (5), pp. 1025-1031. Date of Electronic Publication: 2016 Sep 29. - Publication Year :
- 2017
-
Abstract
- Background and Aims: Currently, 3 guidelines are available for the management of pancreatic cysts. These guidelines vary in their indication for resection of high-risk cysts. We retrospectively compared the final pathologic outcome of surgically removed pancreatic cysts with the indications for resection according to 3 different guidelines.<br />Methods: Patients who underwent pancreatic resection were extracted from our prospective pancreatic cyst database (2006-present). The final histopathologic diagnosis was compared with the initial indication for surgery stated by the guidelines of the International Association of Pancreatology (IAP), European Study Group on Cystic tumors of the Pancreas and American Gastroenterological Association (AGA). We considered surgery in retrospect justified for malignancy, high-grade dysplasia, solid pseudopapillary neoplasms, neuroendocrine tumors or symptom improvement. Furthermore, we evaluated the patients with suspected intraductal papillary mucinous neoplasm (IPMN) separately.<br />Results: Overall, 115 patients underwent pancreatic resection. The preoperative diagnosis was correct in 83 of 115 patients (72%) and differentiation between benign and premalignant in 99 of 115 patients (86%). In retrospect, surgery was justified according to the aforementioned criteria in 52 of 115 patients (45%). For patients with suspected IPMN (n = 75) resection was justified in 36 of 67 (54%), 36 of 68 (53%), and 32 of 54 (59%) of patients who would have had surgery based on the IAP, European, or AGA guidelines, respectively. The AGA guideline would have avoided resection in 21 of 75 (28%) patients, versus 8 of 75 (11%) and 7 of 75 (9%) when the IAP or European guideline would have been applied strictly. Nevertheless, 4 of 33 patients (12%) with high-grade dysplasia or malignancy would have been missed with the AGA guidelines, compared with none with the IAP or European guidelines.<br />Conclusion: Although fewer patients undergo unnecessary surgery based on the AGA guidelines, the risk of missing malignancy or high-grade dysplasia with this guideline seems considerably high.<br /> (Copyright © 2017 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.)
- Subjects :
- Adult
Aged
Carcinoma, Pancreatic Ductal pathology
Female
Humans
Male
Middle Aged
Neoplasms, Cystic, Mucinous, and Serous pathology
Neuroendocrine Tumors pathology
Pancreatic Cyst pathology
Pancreatic Neoplasms pathology
Retrospective Studies
Risk Assessment
Tumor Burden
Carcinoma, Pancreatic Ductal surgery
Neoplasms, Cystic, Mucinous, and Serous surgery
Neuroendocrine Tumors surgery
Pancreatectomy methods
Pancreatic Cyst surgery
Pancreatic Neoplasms surgery
Pancreaticoduodenectomy methods
Practice Guidelines as Topic
Subjects
Details
- Language :
- English
- ISSN :
- 1097-6779
- Volume :
- 85
- Issue :
- 5
- Database :
- MEDLINE
- Journal :
- Gastrointestinal endoscopy
- Publication Type :
- Academic Journal
- Accession number :
- 27693645
- Full Text :
- https://doi.org/10.1016/j.gie.2016.09.027