CoChat
Sign Up
Cited by 224Pancreatitis Pathology and TreatmentPancreatic and Hepatic Oncology ResearchGallbladder and Bile Duct Disorders

Cystic Lesions of the Pancreas: Changes in the Presentation and Management of 1,424 Patients at a Single Institution over a 15-Year Time Period

Open access
Gaujoux, Sébastien, Brennan, Murray F., Gonen, Mithat, D’Angelica, Michael I., DeMatteo, Ronald, Fong, Yuman, Schattner, Mark, DiMaio, Christopher +3 more·2011·Journal of the American College of Surgeons
DOI 10.1016/j.jamcollsurg.2011.01.016PMC PMC3817568
Open this paper in CoChat — free account

Abstract

BACKGROUND: Cystic lesions of the pancreas are being identified more frequently, and a selective approach to resection is now recommended. The aim of this study was to assess the change in presentation and management of pancreatic cystic lesions evaluated at a single institution over 15 years. STUDY DESIGN: A prospectively maintained registry of patients evaluated between 1995 and 2010 for the ICD-9 diagnosis of pancreatic cyst was reviewed. The 539 patients managed from 1995 to 2005 were compared with the 885 patients managed from 2005 to 2010. RESULTS: A total of 1,424 patients were evaluated, including 1,141 with follow-up >6 months. Initial management (within 6 months of first assessment) was operative in 422 patients (37%) and nonoperative in 719 patients (63%). Operative mortality in patients initially submitted to resection was 0.7% (n = 3). Median radiographic follow-up in patients initially managed nonoperatively was 28 months (range 6 to 175 months). Patients followed radiographically were more likely to have cysts that were asymptomatic (72% versus 49%, p < 0.001), smaller (1.5 versus 3 cm, p < 0.001), without solid component (94% versus 68%, p < 0.001), and without main pancreatic duct dilation (88% versus 61%, p < 0.001). Changes prompting subsequent operative treatment occurred in 47 patients (6.5%), with adenocarcinoma identified in 8 (17%) and pancreatic endocrine neoplasm in 4 (8.5%). Thus, of the 719 patients initially managed nonoperatively, invasive malignancy was identified in 12 (1.7%), with adenocarcinoma seen in 1.1%. CONCLUSION: Cystic lesions of the pancreas are being identified more frequently, yet are less likely to present with concerning features of malignancy. Carefully selected patients managed nonoperatively had a risk of malignancy that was equivalent to the risk of operative mortality in those patients who initially underwent resection.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1016/j.jamcollsurg.2011.01.016

Cites

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Approximately 42-63% of resected IPMNs were found to have only low-grade dysplasia.

    “While the goal of surgery is to resect lesions with advanced neoplasia (high-grade dysplasia and/or adenocarcinoma), approximately 42–63% of resected IPMNs were found to have only low-grade dysplasia [12,13,14,15,16,17].”

    From Artificial Intelligence in the Diagnosis and Treatment of Pancreatic Cystic Lesions and Adenocarcinoma (2023) · cites this paper as [13]

    The Results section reports 114 initially resected IPMNs and discusses non-invasive IPMNs, but it does not give the proportion with low-grade dysplasia. Searches for “low-grade dysplasia” and the 42–63% range found no passage in our copy establishing that figure; the cited Table 3 figures were not available in the returned passages (page unavailable). (LLM, conf=0.68)

    Experimental — accuracy not yet measured

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Cites

No references could be resolved yet.

Research works printed but not linked: 36

  1. [1]Lee KS Sekhar A Rofsky NM Prevalence of incidental pancreatic cysts in the adult population on MR imaging Am J Gastroenterol 2010 20354507
  2. [2]Kimura W Nagai H Kuroda A Analysis of small cystic lesions of the pancreas Int J Pancreatol 1995 18 197 206 8708390
  3. [3]Horvath KD Chabot JA An aggressive resectional approach to cystic neoplasms of the pancreas Am J Surg 1999 178 269 274 10587182
  4. [4]Siech M Tripp K Schmidt-Rohlfing B Cystic tumours of the pancreas: diagnostic accuracy, pathologic observations and surgical consequences Langenbecks Arch Surg 1998 383 56 61 9627172
  5. [5]Spinelli KS Fromwiller TE Daniel RA Cystic pancreatic neoplasms: observe or operate Ann Surg 2004 239 651 657 discussion 657-659 15082969 PMC1356273
  6. [6]Walsh RM Vogt DP Henderson JM Natural history of indeterminate pancreatic cysts Surgery 2005 138 665 670 discussion 670-671 16269295
  7. [7]Allen PJ Jaques DP D’Angelica M Cystic lesions of the pancreas: selection criteria for operative and nonoperative management in 209 patients J Gastrointest Surg 2003 7 970 977 14675706
  8. [8]Sahani DV Saokar A Hahn PF Pancreatic cysts 3 cm or smaller: how aggressive should treatment be? Radiology 2006 238 912 919 16439566
  9. [9]Allen PJ D’Angelica M Gonen M A selective approach to the resection of cystic lesions of the pancreas: results from 539 consecutive patients Ann Surg 2006 244 572 582 16998366 PMC1856565
  10. [10]Ferrone CR Correa-Gallego C Warshaw AL Current trends in pancreatic cystic neoplasms Arch Surg 2009 144 448 454 19451487 PMC3806091
  11. [11]O’Toole D Palazzo L Hammel P Macrocystic pancreatic cystadenoma: The role of EUS and cyst fluid analysis in distinguishing mucinous and serous lesions Gastrointest Endosc 2004 59 823 829 15173795
  12. [12]Maire F Voitot H Aubert A Intraductal papillary mucinous neoplasms of the pancreas: performance of pancreatic fluid analysis for positive diagnosis and the prediction of malignancy Am J Gastroenterol 2008 103 2871 2877 18775021
  13. [14]Curry CA Eng J Horton KM CT of primary cystic pancreatic neoplasms: can CT be used for patient triage and treatment? AJR Am J Roentgenol 2000 175 99 103 10882255
  14. [15]Procacci C Biasiutti C Carbognin G Characterization of cystic tumors of the pancreas: CT accuracy J Comput Assist Tomogr 1999 23 906 912 10589565
  15. [16]Sohn TA Yeo CJ Cameron JL Intraductal papillary mucinous neoplasms of the pancreas: an updated experience Ann Surg 2004 239 788 797 discussion 797-799 15166958 PMC1356287
  16. [17]D’Angelica M Brennan MF Suriawinata AA Intraductal papillary mucinous neoplasms of the pancreas: an analysis of clinicopathologic features and outcome Ann Surg 2004 239 400 408 15075659 PMC1356240
  17. [18]Brugge WR Lewandrowski K Lee-Lewandrowski E Diagnosis of pancreatic cystic neoplasms: a report of the cooperative pancreatic cyst study Gastroenterology 2004 126 1330 1336 15131794
  18. [19]Ahmad NA Kochman ML Brensinger C Interobserver agreement among endosonographers for the diagnosis of neoplastic versus non-neoplastic pancreatic cystic lesions Gastrointest Endosc 2003 58 59 64 12838222
  19. [20]Brugge WR Lauwers GY Sahani D Cystic neoplasms of the pancreas N Engl J Med 2004 351 1218 1226 15371579
  20. [21]Nagula S Kennedy T Schattner MA Evaluation of cyst fluid CEA analysis in the diagnosis of mucinous cysts of the pancreas J Gastrointest Surg 2010 20658204
  21. [22]Khalid A Brugge W ACG practice guidelines for the diagnosis and management of neoplastic pancreatic cysts Am J Gastroenterol 2007 102 2339 2349 17764489
  22. [23]Sainani NI Saokar A Deshpande V Comparative performance of MDCT and MRI with MR cholangiopancreatography in characterizing small pancreatic cysts AJR Am J Roentgenol 2009 193 722 731 19696285
  23. [24]Song SJ Lee JM Kim YJ Differentiation of intraductal papillary mucinous neoplasms from other pancreatic cystic masses: comparison of multirow-detector CT and MR imaging using ROC analysis J Magn Reson Imaging 2007 26 86 93 17659551
  24. [25]Carrara S Arcidiacono PG Mezzi G Pancreatic endoscopic ultrasound-guided fine needle aspiration: complication rate and clinical course in a single centre Dig Liver Dis 2010 42 520 523 19955025
  25. [26]Das A Ngamruengphong S Nagendra S Asymptomatic pancreatic cystic neoplasm: a cost-effectiveness analysis of different strategies of management Gastrointest Endosc 2009 70 690 699 e6 19647240
  26. [27]Le Borgne J de Calan L Partensky C Cystadenomas and cystadenocarcinomas of the pancreas: a multiinstitutional retrospective study of 398 cases French Surgical Association Ann Surg 1999 230 152 161 PMC1420857 10450728
  27. [28]Fernandez-del Castillo C Warshaw AL Cystic tumors of the pancreas Surg Clin North Am 1995 75 1001 1016 7660245
  28. [29]Tanaka M Chari S Adsay V International consensus guidelines for management of intraductal papillary mucinous neoplasms and mucinous cystic neoplasms of the pancreas Pancreatology 2006 6 17 32 16327281
  29. [30]Ceppa EP De la Fuente SG Reddy SK Defining criteria for selective operative management of pancreatic cystic lesions: does size really matter? J Gastrointest Surg 2010 14 236 244 19911240
  30. [31]Lee CJ Scheiman J Anderson MA Risk of malignancy in resected cystic tumors of the pancreas < or =3 cm in size: is it safe to observe asymptomatic patients? A multi-institutional report J Gastrointest Surg 2008 12 234 242 18040749
  31. [32]Turner BG Brugge WR Pancreatic cystic lesions: when to watch, when to operate, and when to ignore Curr Gastroenterol Rep 2010 12 98 105 20424981
  32. [33]Reid-Lombardo KM Mathis KL Wood CM Frequency of extrapancreatic neoplasms in intraductal papillary mucinous neoplasm of the pancreas: implications for management Ann Surg 2010 251 64 69 19858708
  33. [34]Choi MG Kim SW Han SS High incidence of extrapancreatic neoplasms in patients with intraductal papillary mucinous neoplasms Arch Surg 2006 141 51 56 discussion 56 16415411
  34. [35]Sugiyama M Atomi Y Extrapancreatic neoplasms occur with unusual frequency in patients with intraductal papillary mucinous tumors of the pancreas Am J Gastroenterol 1999 94 470 473 10022648
  35. [36]Bose D Tamm E Liu J Multidisciplinary management strategy for incidental cystic lesions of the pancreas J Am Coll Surg 2010 211 205 215 20670858 PMC4174396
  36. [37]Das A Wells CD Nguyen CC Incidental cystic neoplasms of pancreas: what is the optimal interval of imaging surveillance? Am J Gastroenterol 2008 103 1657 1662 18564119

Cited by

Sorted by citations

Authors
Gaujoux, S., Brennan, M. F., Gonen, M., D’Angelica, M. I., DeMatteo, R., Fong, Y., Schattner, M., DiMaio, C., Janakos, M., Jarnagin, W. R., & Allen, P. J.
Affiliations
Memorial Sloan Kettering Cancer Center (US)
Corresponding author
Allen, Peter J.
ORCID
Venue
Journal of the American College of Surgeons
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2011-04
Volume
212
Issue
4
Pages
590-600
ISSN
1072-7515 (ISSN-L)
DOI
10.1016/j.jamcollsurg.2011.01.016
PMC
PMC3817568
OpenAlex
W2150102477
Cited by
224
References
0
Citations by year
2026: 5 · 2025: 4 · 2024: 5 · 2023: 10 · 2022: 13 · 2021: 24 · 2020: 15 · 2019: 15 · 2018: 13 · 2017: 22 · 2016: 18 · 2015: 33 · 2014: 17 · 2013: 15 · 2012: 9
FWCI
15.40
Type
journal article
Language
en
Open access
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • Journal of the American College of Surgeons (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Cancer Institute (P30CA008748)
Topics
  • Health Sciences › Medicine › Surgery › Pancreatitis Pathology and Treatment
  • Health Sciences › Medicine › Oncology › Pancreatic and Hepatic Oncology Research
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Gallbladder and Bile Duct Disorders
Keywords
pancreatic cysts, conservative treatment, pancreatic resection, pancreatic ductal adenocarcinoma, pancreatic neuroendocrine tumors, radiographic follow-up, postoperative mortality, solid component, main pancreatic duct dilatation
MeSH terms
Adolescent, Adult, Aged, Aged, 80 and over, Female, Humans, Male, Middle Aged, Pancreatectomy, Pancreatic Cyst, Pancreatic Neoplasms, Retrospective Studies, Time Factors, Cohort Studies, Treatment Outcome, Patient Selection, Young Adult

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review