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invasive disease respectively. Surgery was also shown to meaningfully affect survival (p=0.004), with those that underwent surgery having a median survival of 8 months compared to 2 months for those that did not undergo surgery. Sub-analysis of those that underwent surgery demonstrated that lymphadenectomy was significant (p<0.001), with a median survival of 8 months in those with lymph nodes removed and 1.1 months in those without lymph nodes removed. However, nodal positivity did not have an imperative effect on survival (p=0.7) in those that underwent lymphadenectomy. The univariate analysis resulted in a hazard ratio (HR) of 9.14 for those with distant metastasis versus localized disease (HR=1.00, p=0.01), and a hazard ratio of 0.33 for patients undergoing cancer-directed surgery versus no surgery (HR=1.00, p=0.01). With multivariate analysis, only metastatic disease (HR=5.93, p=0.04) remained a significant predictor of survival. Conclusion: Pancreatic carcinosarcoma carries a poor prognosis, with median survival under one year from the time of diagnosis. Metastatic disease was a significant predictor of early mortality as identified by both univariate and multivariate analysis. Evidence also indicates that surgery may have a beneficial effect on survival, suggesting that those who are good candidates for surgery should undergo resection.

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Methods: Patients undergoing treatment of simple hepatic cysts at our institution between January 2008 to July 2019 were identified by retrospective record review. Demographic data, preoperative symptoms, cyst characteristics, surgical details, and postoperative outcomes were determined from retrospective record review. Cyst size was defined as the greatest measured diameter on axial imaging. If multiple cysts were present, the largest cyst size was used for analysis. Linear regression for continuous variables and logistic regression for categorical variables was used to determine correlations between cyst size and postoperative outcomes. Results: 120 patients with simple hepatic cysts were identified and included in our analysis. The average cyst size was 12.0AE5.5 cm, 85.8% of patients were symptomatic, and pain (83.3%) was the predominant symptom. 114 (95%) of patients were treated with minimally invasive surgery, mean estimated blood loss (EBL) was 193AE413 mL, mean operative time was 123AE59 min, conversion to open rate was 1.8%, and the rate of simultaneous hepatectomy was 23.3%. Rate of reoperation for recurrence was 4.2%. Regression analysis considering size as a continuous variable demonstrated that cyst size was weakly correlated with operative time (R2=0.0683; p=0.0056), however it was not associated with EBL (p=0.4874), need for hepatectomy (p=0.4094), length of stay (p=0.1305), complications (p=0.2943), Clavien-Dindo grade of complications (p=0.4072), or reoperation for recurrence (p=0.2488). Regression analysis was then carried out to determine correlation between cyst percentile size and postoperative outcomes. Using cutoffs at the 10th, 25th, 50th, 75th, and 90th percentiles, there was no correlation between these cutoffs and operative time. There were no correlations between any percentile cutoffs and EBL, need for hepatectomy, length of stay, complications, or Clavien-Dindo grade of complications Conclusion: For surgical therapy of simple hepatic cysts there is a weak correlation with cyst size and operative time, however there is no correlation between clinically relevant patient outcomes and cyst size. This demonstrates that for patients with simple hepatic cysts, the size of the cyst does not predict patient outcomes. Traditional definitions of "giant" simple hepatic cysts are irrelevant.

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