Pancreatic cysts: a proposed management algorithm based on current evidence

• Published in: The American journal of surgery Vol. 193; no. 6; pp. 749 - 755
• Main Authors: Goh, Brian K.P., Tan, Yu-Meng, Chung, Yaw-Fui Alexander, Chow, Pierce K.H., Cheow, Peng-Chung, Thng, Choon-Hua, Mesenas, Steven, Wong, Wai-Keong, Ooi, London L.P.J.
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.06.2007; Elsevier; Elsevier Limited
• Subjects: Algorithms; Biological and medical sciences; Biomarkers; Biopsy, Fine-Needle; Cystic lesion; Cystic neoplasm; Cysts; Diagnosis, Differential; Disease Progression; Endosonography; General aspects; Humans; Intraductal papillary neoplasm; Management; Medical imaging; Medical sciences; Mucinous cystic neoplasm; NMR; Nuclear magnetic resonance; Pancreas; Pancreatectomy - methods; Pancreatic; Pancreatic cyst; Pancreatic Cyst - diagnosis; Pancreatic Cyst - surgery; Pancreatic Neoplasms - diagnosis; Prognosis; Risk Factors; Serous cystic neoplasm; Surgery; Tomography, X-Ray Computed; Pancreatic cyst; Intraductal papillary neoplasm; Mucinous cystic neoplasm; Serous cystic neoplasm; Pancreatic; Management; Cystic neoplasm; Cystic lesion; Algorithm; Decision tree; Evidence-based medicine; Clinical management; Treatment; Surgery; Cyst; Benign neoplasm; Pancreas
• ISSN: 0002-9610; 1879-1883; 1879-1883
• DOI: 10.1016/j.amjsurg.2006.07.019

Currently, the management strategy of pancreatic cyst (PC) remains controversial because of the inability to diagnose this type of cyst accurately and the limited knowledge of its natural history. Previously, many clinicians have advocated an aggressive resectional policy. This approach is no longer appropriate, and the number of PCs detected incidentally has increased. This study reviews the present literature and attempts to provide a management algorithm of pancreatic cysts based on currently available evidence. A Medline search was conducted to identify studies investigating PC, with particular emphasis placed on studies addressing its diagnosis and management. Additional articles were obtained from the reference lists of key articles and recent reviews. Based on current evidence, the optimal management of PC remains an art and should be individualized based on the risk–benefit ratio of surgery, which is influenced by multiple factors, such as the patient’s potential life expectancy, surgical risk; and malignant potential of the cyst. Our proposed management algorithm is based on an individual’s predicted risk–benefit ratio of surgery. Prospective evaluation of the algorithm is needed to determine its integrity.