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

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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

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losigame
General Hospitals
Pancreas
Neoplasms
Pancreatic Neoplasms
Serous Cystadenoma
Survival
Early Diagnosis
Referral and Consultation
Demography
Databases
Pathology

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

851 resected cystic tumors of the pancreas : A 33-year experience at the Massachusetts General Hospital. / Valsangkar, Nakul P.; Morales-Oyarvide, Vicente; Thayer, Sarah P.; Ferrone, Cristina R.; Wargo, Jennifer A.; Warshaw, Andrew L.; Fernández-Del Castillo, Carlos.

In: Surgery (United States), Vol. 152, No. 3 SUPPL., 09.2012, p. S4-S12.

Research output: Contribution to journalArticle

Valsangkar, NP, Morales-Oyarvide, V, Thayer, SP, Ferrone, CR, Wargo, JA, Warshaw, AL & Fernández-Del Castillo, C 2012, '851 resected cystic tumors of the pancreas: A 33-year experience at the Massachusetts General Hospital', Surgery (United States), vol. 152, no. 3 SUPPL., pp. S4-S12. https://doi.org/10.1016/j.surg.2012.05.033
Valsangkar, Nakul P. ; Morales-Oyarvide, Vicente ; Thayer, Sarah P. ; Ferrone, Cristina R. ; Wargo, Jennifer A. ; Warshaw, Andrew L. ; Fernández-Del Castillo, Carlos. / 851 resected cystic tumors of the pancreas : A 33-year experience at the Massachusetts General Hospital. In: Surgery (United States). 2012 ; Vol. 152, No. 3 SUPPL. pp. S4-S12.
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title = "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.",
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AU - Valsangkar, Nakul P.

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AU - Thayer, Sarah P.

AU - Ferrone, Cristina R.

AU - Wargo, Jennifer A.

AU - Warshaw, Andrew L.

AU - Fernández-Del Castillo, Carlos

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N2 - 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.

AB - 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.

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