Allen Peter J, D'Angelica Michael, Gonen Mithat, Jaques David P, Coit Daniel G, Jarnagin William R, DeMatteo Ronald, Fong Yuman, Blumgart Leslie H, Brennan Murray F
Memorial Sloan-Kettering Cancer Center, USA.
Ann Surg. 2006 Oct;244(4):572-82. doi: 10.1097/01.sla.0000237652.84466.54.
To define a group of patients with pancreatic cysts who do not require resection.
The increased use of cross-sectional imaging has resulted in an increased identification of small, asymptomatic pancreatic cysts. Data have not been available to determine which lesions should be resected.
All patients evaluated at our institution between January 1995 and January 2005 for the ICD-9 diagnosis of pancreatic cyst were reviewed. Analysis was performed to identify associations between patient and cyst characteristics, and selection of operative or nonoperative management.
Pancreatic cysts were evaluated in 539 patients. Initial management was operative in 170 patients (32%), and nonoperative (radiographic follow-up) in 369 patients (68%). Factors associated with initial operative management included presence of a solid component (45% vs. 6%, P < 0.001), larger size of the lesion (mean 4.8 cm vs. 2.4 cm, P = 0.001), and presence of symptoms (44% vs. 16%, P = 0.001). Malignancy was present in 18% (32 of 170) of patients initially resected. Mucinous tumors (n = 18) were the most common malignant histologic subtype. None of the invasive cancers arising from mucinous cysts was <3 cm. Median radiographic follow-up in patients initially managed nonoperatively was 24 months (range, 1-172 months). In 29 patients (8%), changes developed within the cyst that resulted in resection; malignancy was present in 11 of 39 (38%), representing 3% (11 of 369) of all patients being followed radiographically.
Selected patients with cystic lesions <3 cm in diameter and without a solid component may be followed radiographically with a malignancy risk (3% this study) that approximates the risk of mortality from resection. Malignancy within mucinous tumors is associated with size, and small mucinous tumors are very unlikely to be malignant.
定义一组不需要进行切除手术的胰腺囊肿患者。
横断面成像技术应用的增加导致了更多无症状小胰腺囊肿的发现。目前尚无数据可用于确定哪些病变需要切除。
回顾了1995年1月至2005年1月间在我院接受评估且国际疾病分类第九版（ICD - 9）诊断为胰腺囊肿的所有患者。进行分析以确定患者和囊肿特征之间的关联，以及手术或非手术治疗的选择。
对539例胰腺囊肿患者进行了评估。170例患者（32%）初始治疗为手术治疗，369例患者（68%）为非手术治疗（影像学随访）。与初始手术治疗相关的因素包括存在实性成分（45%对6%，P < 0.001）、病变较大（平均4.8 cm对2.4 cm，P = 0.001）以及存在症状（44%对16%，P = 0.001）。最初接受手术切除的患者中18%（170例中的32例）存在恶性肿瘤。黏液性肿瘤（n = 18）是最常见的恶性组织学亚型。黏液性囊肿产生的浸润性癌无一小于3 cm。最初接受非手术治疗患者的影像学随访中位时间为24个月（范围1 - 172个月）。29例患者（8%）囊肿出现变化后接受了切除手术；39例中的11例（38%）存在恶性肿瘤，占所有接受影像学随访患者的3%（369例中的11例）。
直径小于3 cm且无实性成分的特定囊性病变患者可进行影像学随访，其恶性风险（本研究为3%）接近手术切除的死亡风险。黏液性肿瘤中的恶性肿瘤与大小有关，小的黏液性肿瘤极不可能是恶性的。
