Evolving Trends in Pancreatic Cystic Tumors: A 3-Decade Single-Center Experience with 1290 Resections

Introduction: Incidental-discovery of pancreatic cystic lesions has increased and has led to a rise in pancreatic resections. It is important to analyze surgical outcomes from these procedures, and the prevalence of malignancy, pre-malignancy, and resections for purely benign lesions, some of which may be unintended. We aim to describe our institutional experience with resected cystic lesions over a 30-year period, with emphasis on the changes in clinical presentation over time. Methods: From prospectively maintained databases, 1290 patients who underwent pancreatic resection between 1990 and 2020 for a pancreatic cystic lesion were identified. In addition to demographics and diagnosis, presence of symptoms, incidental discovery, diagnostic studies, type of surgery, postoperative outcomes, and concordance between presumptive diagnosis and final histopathology were recorded. Results: 1290 patients were identified, 62% female with mean age of 60 y. 57% of tumors were incidentally-discovered. 90-day operative mortality was 0.9% and major morbidity 14.4%. There were 23 different diagnoses, but IPMN, MCN, and serous cystadenoma comprised 80% of cases. Concordance between preoperative and final histopathological diagnosis increased over time and is currently 80%, rising in parallel with the use of EUS, cytological and molecular analysis. Conclusion: Indications and diagnostic work-up of cystic tumors of the pancreas have changed over time. Surgical resection can be performed with very low mortality and acceptable morbidity and diagnostic accuracy is currently 80%. About 10% of patients are still undergoing surgery for purely benign lesions that were presumed to be malignant or premalignant. Further refinements in diagnostic tests are required.