Management of suspected pancreatic cystic tic neoplasms based on cyst size
Management of suspected pancreatic cystic tic neoplasms based on cyst size
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DOI：
10.1016/j.surg.2008.06.013
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发表时间：
2008-10-01
期刊：
影响因子：
3.8
通讯作者：
Brown, Nancy
中科院分区：
文献类型：
--
作者：
Walsh, R. Matthew;Vogt, David P.;Brown, Nancy
背景。囊性胰腺肿瘤的评估和治疗仍然存在问题。国际共识指南建议切除大于 3 厘米的病灶。方法。我们根据囊肿大小 3 cm 回顾了前瞻性胰腺囊性肿瘤数据库的结果。结果。 1999年至2006年共治疗500名患者，其中患者349人。 (70%)囊肿小于或等于3厘米：293例(84%)未手术，其中243例非粘液性囊肿：2例观察失败(0.8%，平均随访24个月)。囊肿小于或等于3厘米的56名患者最初接受了手术（16%），其中23名无症状患者。组织病理学显示 20 例为导管内乳头状粘液性肿瘤 (IPMN)，18 例为粘液性囊性肿瘤 (MCN)，5 例为浆液性囊腺瘤。12 例患有癌 (21%)。共有 151 名患者（30%）囊肿大于 cm：87 名（50%）未手术，其中 68 名非粘液性囊肿：2 名观察失败（2.9%，平均随访 47 个月）。囊肿大于 3 cm 的患者 64 例（42%）初次手术，最终病理结果显示 MCN 27 例，浆液性囊腺瘤 11 例，IPMN 7 例，假性囊肿 7 例。12 例为癌（19%）。囊肿小于或等于 3 cm 的患者接受手术的可能性较小（16 vs 42%；P < .001），症状较少（39 vs 50%；P=.017），而且年龄较大（平均年龄，65 vs 61 岁；P=.03）。如果仅根据体型来管理患者，多达 20% 的患者会接受不适当的治疗。与大小相比，基于抽吸的管理在预测粘液性肿瘤方面明显更好（75% vs 57%；P
Background. Evaluation and management of cystic pancreatic neoplasms remain problematic. International consensus guidelines have advised resection for lesions greater than 3 cm.Methods. We reviewed our prospective pancreatic cystic neoplasm database for outcomes based on a cyst size of 3 cm.Results. Five hundred patients have been managed from 1999 to 2006. There were 349 patients. (70%) with cysts less than or equal to 3 cm: 293 (84%) were not operated, including 243 nonmucinous cysts: 2 failed observation (0.8%, mean follow-up of 24 months). Fifty-six patients with cysts less than or equal to 3 cm were initially operated (16%), including 23 asymptomatic patients. Histopathology showed intraductal papillary mucinous neoplasm (IPMN) in 20, mucinous cystic neoplasm (MCN) in 18, and serous cystadenoma in 5. Twelve had carcinoma (21%). A total of 151 patients (30%) had cysts greater than cm: 87(50%) were not operated, including 68 that were nonmucinous: 2 failed observation (2.9%, mean follow-up of 47 months). Sixty-four patients with cysts greater than 3 cm (42%) were initially operated, and final pathology showed MCN in 27, serous cystadenoma in 11, IPMN in 7, and pseudocyst in 7. Twelve had carcinoma (19%). Patients with cysts less than or equal to 3 cm were less likely to be operated (16 vs 42%; P < .001), less often symptomatic (39 vs 50%; P=.017), while older (mean age, 65 vs 61 years; P=.03). Had patients been managed by size alone, up to 20% would have received inappropriate treatment. Management based on aspiration was significantly better in predicting mucinous neoplasms compared with size (75% vs 57%; P