Predictive factors for surgery among patients with pancreatic cysts in the absence of high-risk features for malignancy

Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract
Susan Y QuanWalter G Park

Abstract

Without a reliable biopsy technique for pancreatic cysts, consensus-based guidelines are used to guide surgical utilization. The primary objective of this study was to characterize the proportion of operations performed outside of these guidelines. A 5-year retrospective review between July 1, 2007, and June 30, 2012, was performed of consecutive patients seen at a single tertiary medical center for a pancreatic cyst. Manual chart review for relevant clinical variables and cyst characteristics was performed. During this period, 148 patients underwent surgery, and of these, 23 (16 %) patients had no high-risk criteria by the 2006 Sendai criteria. None of these harbored high-grade dysplastic or cancerous lesions. A high cyst carcinoembryonic antigen (CEA) level (35 %), patient anxiety (26 %), and physician concern (22 %) were explicit reasons to proceed to surgery. An elevated cyst CEA level >192 ng/ml was the most significant predictor (OR 5.14 (95 % confidence interval (CI) 1.47-18.0) for surgery without high-risk criteria. A high cyst CEA level was significantly associated with the decision to operate outside of consensus-based guidelines. The misuse of cyst CEA in the management of pancreatic cysts negatively impacts patient ...Continue Reading

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Citations

Jan 25, 2017·Digestive Diseases and Sciences·Michael SighinolfiWalter G Park
Jun 14, 2017·Pancreas·Jodie A Barkin, Jamie S Barkin
Apr 21, 2017·Clinical Cancer Research : an Official Journal of the American Association for Cancer Research·Sam L IvryCharles S Craik

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