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

Nakul P. Valsangkar, Vicente Morales-Oyarvide, Sarah P. Thayer, Cristina R. Ferrone, Jennifer A. Wargo, Andrew L. Warshaw, Carlos Fernández-Del Castillo

Research output: Contribution to journalArticle

199 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)S4-S12
JournalSurgery (United States)
Volume152
Issue number3 SUPPL.
DOIs
StatePublished - Sep 2012

ASJC Scopus subject areas

  • Surgery

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    Valsangkar, N. P., Morales-Oyarvide, V., Thayer, S. P., Ferrone, C. R., Wargo, J. A., Warshaw, A. L., & Fernández-Del Castillo, C. (2012). 851 resected cystic tumors of the pancreas: A 33-year experience at the Massachusetts General Hospital. Surgery (United States), 152(3 SUPPL.), S4-S12. https://doi.org/10.1016/j.surg.2012.05.033