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

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.

Fig 1

Distribution of pathologic diagnoses in 851 resected cystic neoplasms of the pancreas. Lesions classified as “other” included pseudocysts, 25; benign epithelial cysts, 11; acinar cell cystadenomas and cystad-enocarcinomas, 3; lymphoepithelial cysts, 5; choledochal cysts, 4; lymphangiomata, 4; hemangiomata, 2; and other unclassified epithelial cysts.

Fig 2

Changing trends in the duration of stay by the type of operative procedure.

Fig 3

Kaplan-Meier survival curve for overall survival by pathologic diagnoses.