Changing trends in the clinicopathological features, practices and outcomes in the surgical management for cystic lesions of the pancreas and impact of the international guidelines: Single institution experience with 462 cases between 1995-2018

Brian K P Goh; Rachel H S Park; Ye-Xin Koh; Jin-Yao Teo; Ek-Khoon Tan; Peng-Chung Cheow; Choon-Hua Thng; Albert S Low; Damien M Tan; Pierce K H Chow; Chung-Yip Chan; Alexander Y F Chung; London L P J Ooi

doi:10.1016/j.pan.2020.09.019

Changing trends in the clinicopathological features, practices and outcomes in the surgical management for cystic lesions of the pancreas and impact of the international guidelines: Single institution experience with 462 cases between 1995-2018

Pancreatology. 2020 Dec;20(8):1786-1790. doi: 10.1016/j.pan.2020.09.019. Epub 2020 Sep 28.

Authors

Affiliations

¹ Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore; Duke National University of Singapore Medical School, Singapore. Electronic address: bsgkp@hotmail.com.
² Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
³ Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore; Duke National University of Singapore Medical School, Singapore.
⁴ Department of Oncologic Imaging, National Cancer Center Singapore, Singapore.
⁵ Department of Radiology, Singapore General Hospital, Singapore.
⁶ Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore.

PMID: 33008749
DOI: 10.1016/j.pan.2020.09.019

Abstract

Introduction: 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.

Methods: 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.

Results: 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^SG06 and HR^FG12 CLP with a corresponding lower proportion of LR^SG06 and LR^FG12 being resected. This resulted in a significantly higher proportion of resected CLP whereby the final pathology confirmed that a surgery was actually indicated.

Conclusions: 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^SG06 and HR^FG06 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.

Keywords: Cystic lesion of the pancreas; Fukuoka guidelines; International guidelines; Intraductal papillary mucinous neoplasm; Pancreatic cystic neoplasm.

MeSH terms

CA-19-9 Antigen
Endosonography
Female
Humans
Magnetic Resonance Imaging
Male
Middle Aged
Pancreatectomy
Pancreatic Cyst* / diagnosis
Pancreatic Cyst* / surgery
Practice Guidelines as Topic*

Substances

CA-19-9 Antigen