Analysis of cyst size and tumor markers in the management of pancreatic cysts: support for the original Sendai criteria.

Abstract

BACKGROUND:

In 2006, the Sendai Consensus Guidelines identified size >3.0 cm as the only independent predictor of malignancy in incidentally discovered pancreatic cysts. The 2012 updated guidelines increased emphasis on radiographic features over size. Earlier studies included patients with preoperatively diagnosed carcinoma or with a corresponding mass. In this report, we characterize the use of size and serum tumor markers in the initial evaluation of pancreatic cystic neoplasms without preoperatively diagnosed adenocarcinoma and correlate them with clinical and pathologic outcomes.

STUDY DESIGN:

A retrospective cohort study was undertaken of 112 patients with a resected pancreatic cystic neoplasm. Patient demographics, cyst characteristics, preoperative serum tumor markers, morbidity, and mortality were captured. Statistical analysis included nonparametric tests of comparison, multivariate logistic regression, and receiver operating characteristic curve analyses.

RESULTS:

One hundred and twelve pancreatic cystic neoplasms were resected; there was one perioperative death. Mucinous cysts were common (78%), followed by serous cysts (13%). In total, 17% of cysts harbored malignancy. On multivariate analysis, the risk of malignancy in cysts≥3 cm was more than 4 times that of smaller cysts (relative risk (RR)=4.32; 95% CI, 1.55-12.07). There was no significant difference in serum CEA, cancer antigen 19-9, or cyst-fluid CEA levels between the benign and malignant groups. At a median follow-up of 30 months, the incidence of diabetes was 15%.

CONCLUSIONS:

Surgical resection of pancreatic cysts can be performed with low perioperative mortality and acceptable long-term morbidity. Use of cyst size as a rationale for resection of cystic lesion, as per the Sendai criteria, is justified.

• Authors: Rebecca L Hoffman, Jenna L Gates, Michael L Kochman, Gregory G Ginsberg, Nuzhat A Ahmad, Vinay Chandrasekhara, Emma E Furth, Charles M Vollmer, Jeffrey A Drebin
• Journal: Journal of the American College of Surgeons (J Am Coll Surg) Vol. 220 Issue 6 Pg. 1087-95 (Jun 2015) ISSN: 1879-1190 [Electronic] United States
• PMID: 25868415 (Publication Type: Evaluation Study, Journal Article)
• Copyright: Copyright © 2015 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

Chemical References

• Biomarkers, Tumor

Topics

• Adenocarcinoma (blood, diagnosis, pathology, surgery)
• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Biomarkers, Tumor (blood)
• Decision Support Techniques
• Diagnosis, Differential
• Female
• Follow-Up Studies
• Humans
• Logistic Models
• Male
• Middle Aged
• Multivariate Analysis
• Pancreatic Cyst (blood, diagnosis, pathology, surgery)
• Pancreatic Neoplasms (blood, diagnosis, pathology, surgery)
• Practice Guidelines as Topic
• ROC Curve
• Retrospective Studies
• Young Adult