Session: Oral Paper Presentations - Biliary/Pancreas
13 (S0003). - A 5-Year Post-Surgical Follow-Up of 100 Patients With Pancreatic Cysts: Evaluating the Incidence Rates and Predictors of Recurrent Pancreatic Cysts, High-Risk Transformation and Malignant Transformation
Mohannad Abou Saleh, MD1, Motasem Alkhayyat, MD1, Farhan M. Qayyum, DO, MA2, Woan Kim, DO1, Ashraf Almomani, MD1, Alaa Habash, MD1, James Bena, MS1, Tyler Stevens, MD1, Toms Augustin, MD, MPH1, Robert Simon, MD1, Charles Martin, MD1, Carlos Roberto Simons-Linares, MD, MSc1, Prabhleen Chahal, MD1; 1Cleveland Clinic Foundation, Cleveland, OH; 2Cleveland Clinic Foundation, Warrensville Heights, OH
Introduction: Data on the post-surgical course of patients with surgically excised pancreatic cysts (PC) are lacking. Current guidelines and recommendations for follow up are based on expert opinion with low quality of evidence. We aim to describe the post-surgical course of PC patients and evaluate the rates and predictors of recurrent cysts, high-risk and malignant transformation. Methods: A cohort study of a prospectively maintained database of patients with abdominal MRI diagnosis of PC from 2008-2018 was conducted. Patients, older than 18, with data on initial diagnosis and surgical intervention were included. Patients with total pancreatectomy were excluded. Outcomes were measured at 1, 3, and 5 years. These included new or recurrent cysts, rate of growth (size, number) of these cysts, high-risk transformation (new communication with pancreatic duct (PD) or dilation, new dilation of main PD, change in size of previous dilation, extension of cyst location, cyst >=3 cm, new thickened enhanced cyst wall, new non-enhanced nodule, new distal pancreatic atrophy, new abrupt change in main PD size, new lymphadenopathy) and malignant transformation (dysplasia or malignant cells). Kaplan-Meier estimates and Cox proportional hazards were used for time to high-risk transformation and surgery. Mixed effect logistic regression models were used to evaluate increased growth over time. Results: Of the 1,789 patients evaluated, 104 underwent surgical intervention for PC with 37 (37.4%) cases undergoing pancreaticoduodenectomy and 62 (62.6%) undergoing distal pancreatectomy. There were 63% IPMN (74.55% side-branch), 14% MCN, 8% serous cystadenoma, 6% neuroendocrine neoplasm, 6% pseudocyst and 3% solid-pseudopapillary neoplasm. On surgical pathology, 27% had adenocarcinoma and 14% had high-grade dysplasia. At 1 year after surgery, 34.5% had recurrent cysts with 5.1% high-risk transformation and 11.7% malignant transformation. This increased to 64.8%, 13.7% and 19% respectively by 5 years (Figure). There were no statistically significant predictors of the measured outcomes. Mortality rate was 13.5% overall with 5.8% related to pancreatic cause over 5 years. Discussion: We evaluated the post-operative course of surgically excised PC. The incidence of measured outcomes increased over time. There was >10% incidence of malignant transformation by one year and 19% by 5 years. This confirms the need for close follow-up and continued surveillance of PC after surgical excision.
Disclosures: Mohannad Abou Saleh indicated no relevant financial relationships. Motasem Alkhayyat indicated no relevant financial relationships. Farhan Qayyum indicated no relevant financial relationships. Woan Kim indicated no relevant financial relationships. Ashraf Almomani indicated no relevant financial relationships. Alaa Habash indicated no relevant financial relationships. James Bena indicated no relevant financial relationships. Tyler Stevens indicated no relevant financial relationships. Toms Augustin indicated no relevant financial relationships. Robert Simon indicated no relevant financial relationships. Charles Martin indicated no relevant financial relationships. Carlos Roberto Simons-Linares indicated no relevant financial relationships. Prabhleen Chahal indicated no relevant financial relationships.