General and GI Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Surgery. 2012 Sep;152(3 Suppl 1):S4-12. doi: 10.1016/j.surg.2012.05.033. Epub 2012 Jul 6.
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.
Patient characteristics, including demographics, pathology, and survival, were analyzed over 5 time periods between 1978 and 2011.
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%.
Cystic neoplasms of the pancreas are being diagnosed and treated with increasing frequency. At present, most are incidentally discovered intraductal papillary mucinous neoplasms.
本研究旨在通过对一家学术转诊中心外科数据库中 33 年来的患者进行回顾性研究，分析胰腺囊性肿瘤的诊断和治疗趋势。
分析了 1978 年至 2011 年 5 个时期的患者特征，包括人口统计学、病理学和生存情况。
33 年来，共有 851 例连续患者因胰腺囊性肿瘤而行切除术。65%的患者为女性，平均年龄为 60 岁。最常见的病理诊断为导管内乳头状黏液性肿瘤（38%）、黏液性囊腺瘤（23%）、浆液性囊腺瘤（16%）和囊性神经内分泌肿瘤（7%）。随着时间的推移，手术数量呈逐步增加趋势（1978 年至 1989 年为 67 例；2005 年至 2011 年为 376 例），同时偶然发现病变的比例也呈平行增加（22%至 50%）。在最初的 2 个时期（在导管内乳头状黏液性肿瘤被明确为一种独特实体之前），导管内乳头状黏液性肿瘤的诊断非常少见（22%），但在最后 2 个时期（41%和 49%）则占主导地位，而在第一个时期占胰腺囊性肿瘤的 3%的囊性神经内分泌肿瘤，现在占胰腺囊性肿瘤的 8%以上。随着时间的推移，恶性肿瘤的比例下降（1978 年至 1989 年为 41%；2005 年至 2011 年为 12%），这可能反映了对癌前病变的更早诊断和治疗。尽管手术死亡率极低（849 例中 4 例，0.5%），但术后并发症发生率为 38%。所有黏液性病变的 5 年总生存率为 87%。
胰腺囊性肿瘤的诊断和治疗频率正在增加。目前，大多数是偶然发现的导管内乳头状黏液性肿瘤。
