Risk of Malignancy in Resected Cystic Tumors of the Pancreas ≤3 cm in Size: Is it Safe to Observe Asymptomatic Patients? A Multi-institutional Report

摘要: Recent international consensus guidelines propose that cystic pancreatic tumors less than 3 cm in size asymptomatic patients with no radiographic features concerning for malignancy are safe to observe; however, there is little published data support this recommendation. The purpose of study was determine the prevalence group using resection databases from five high-volume centers assess appropriateness these guidelines. All resections performed neoplasms ≤3 were evaluated over time period 1998–2006. One hundred sixty-six cases identified, and clinical, radiographic, pathological reviewed. correlation age, gender, symptoms (abdominal pain, nausea vomiting, jaundice, presence pancreatitis, unexplained weight loss, anorexia), suggestive by either computed tomography, magnetic resonance imaging, or endoscopic ultrasound (presence solid component, lymphadenopathy, dilated main duct common bile duct), assessed univariate multivariate analysis. Among 166 cm, 135 benign [38 serous cystadenomas, 35 mucinous neoplasms, 60 intraductal papillary (IPMN), 1 tumor, islet cell tumor], whereas 31 malignant (14 adenocarcinomas 13 invasive carcinomas 4 situ arising setting IPMN). A greater incidence seen female (99/166, 60%). Gender a predictor pathology, male having higher (19/67, 28%) compared (12/99, 12%; p < 0.02). Older age associated (mean 67 years disease vs 62 lesions (p 0.05). majority symptomatic (28/31, 90%). Symptoms correlated included jaundice 0.001), loss 0.003), anorexia Radiographic component 0.0001), dilation = 0.002), lymphadenopathy 0.002). Twenty-seven 31(87%) had at least one feature malignancy. Forty-five (27%) identified as neoplasms. but three (6.6%) disease. Of features, out 30 (3.3%) (carcinoma side branch Malignancy older (jaundice, (solid dilation, lymphadenopathy). displayed discernable who underwent resection, occult 3.3%. This suggests small have low risk can be selective may appropriate.