While most of pancreatic cysts follow a benign course, a small but significant number are either malignant at the time of diagnosis or have the potential to develop into pancreatic cancer. The dilemma for both patient and clinician is determining which cysts to leave alone and which to surgically remove.
Now, a research team has developed a tool to help guide asymptomatic pancreatic cyst treatment. "Surgery may not be the best initial approach for all patients diagnosed with a specific pancreatic cyst. The new tool may help with decision-making and mapping out a treatment plan," said study author Brennan Spiegel.
Using decision-analysis software, the research team evaluated a set of hypothetical patients ranging in age from 65 to 85 with a variety of asymptomatic pancreatic cysts, ranging in size from half a centimetre to greater than three centimetres and located in the head of the pancreas. The evaluation tool compared four competing treatment strategies: surgical removal of the cyst, annual non-invasive imaging surveillance with MRI or CT, annual endoscopic ultrasound and no treatment.
While the tool takes into account patient age, health, cyst size and surgical risk, it also considers whether the patient values overall survival, no matter the quality of life, or if he or she prefers balancing quantity and quality of life by pursuing less invasive medical measures, which may lead to shorter survival.
The researchers found that to maximize overall survival, regardless of the quality of life, surgical removal was the dominant strategy for a cyst greater than two centimetres, despite the patient's age or other health issues — this is smaller than the three centimetres threshold supported by current treatment guidelines for surgical intervention. Surveillance was the dominant strategy for any cyst less than one centimetre, which is similar to current guidelines.
For patients focused on optimizing both quantity and quality of life, either the "do nothing" approach or surveillance strategy appeared optimal for those between the ages of 65 and 75 with cysts less than three centimetres. For patients over age 85, non-invasive surveillance dominated if quality of life was important, most likely because surgical benefits are often outweighed by the poor quality of life experienced post-operatively in this population.
MEDICA.de; Source: University of California, Los Angeles (UCLA), Health Sciences