Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore; Duke National University of Singapore Medical School, Singapore.
Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Pancreatology. 2020 Dec;20(8):1786-1790. doi: 10.1016/j.pan.2020.09.019. Epub 2020 Sep 28.
The impact on clinical practice of the international guidelines including the Sendai Guidelines (SG06) and Fukuoka Guidelines (FG12) on the management of cystic lesions of the pancreas (CLP) has not been well-studied. The primary aim was to examine the changing trends and outcomes in the surgical management of CLP in our institution over time and to determine the impact of these guidelines on our institution practice.
462 patients with surgically-treated CLP were retrospectively reviewed and classified under the 2 guidelines. The cohort was divided into 3 time periods: 1998-2006, 2007-2012 and 2013 to 2018.
Comparison across the 3 time periods demonstrated significantly increasing frequency of older patients, asymptomatic CLP, male gender, smaller tumor size, elevated Ca 19-9, use of magnetic resonance imaging (MRI) and use of endoscopic ultrasound (EUS) prior to surgery. There was also significantly increasing frequency of adherence to the international guidelines as evidenced by the increasing proportion of HR and HR CLP with a corresponding lower proportion of LR and LR being resected. This resulted in a significantly higher proportion of resected CLP whereby the final pathology confirmed that a surgery was actually indicated.
Over time, there was increasing adherence to the international guidelines for the selection of patients for surgical resection as evidenced by the significantly increasing proportion of HR and HR CLPs undergoing surgery. This was associated with a significantly higher proportion of patients with a definitive indication for surgery. These suggested that over time, there was a continuous improvement in our selection of appropriate CLP for surgical treatment.
国际指南（包括仙台指南（SG06）和福冈指南（FG12））对胰腺囊性病变（CLP）管理的临床实践影响尚未得到充分研究。主要目的是研究随着时间的推移，我们机构中 CLP 手术管理的变化趋势和结果，并确定这些指南对我们机构实践的影响。
回顾性分析了 462 例接受手术治疗的 CLP 患者，并根据这两个指南进行分类。该队列分为 3 个时期：1998-2006 年、2007-2012 年和 2013-2018 年。
3 个时期的比较表明，老年患者、无症状 CLP、男性、肿瘤较小、CA19-9 升高、术前使用磁共振成像（MRI）和内镜超声（EUS）的频率显著增加。同时，国际指南的遵循率也显著增加，这表现为 HR 和 HR CLP 的比例增加，而 LR 和 LR 被切除的比例相应降低。这导致接受手术的 CLP 比例显著增加，最终病理证实确实需要手术。
随着时间的推移，越来越多的患者符合国际指南选择手术切除的标准，这表现为 HR 和 HR CLP 接受手术的比例显著增加。这与接受手术的患者有明确手术指征的比例显著增加有关。这些表明，随着时间的推移，我们对合适的 CLP 进行手术治疗的选择不断得到改善。
