Importance of cause in the outcome of pancreatic pseudocysts

We reviewed our experience with 120 patients presenting with pancreatic pseudocysts over a 13-year period, comparing management and outcome prior to (n = 45) and after (n = 75) the more general use of CT scan. We found that despite the more frequent use of CT scan for diagnosis, patient presentation and morbidity and mortality associated with pseudocysts has not changed. Management of chronic pseudocysts and acute pseudocysts less than 5 cm has not changed. However, acute pseudocysts larger than 5 cm are more frequently managed by observation alone with intervention reserved for cysts present for longer than 6 weeks, cysts associated with severe symptoms, or a suspicion of cyst-related complications. In addition, due to the risk of complication or failure we reserve percutaneous drainage for a specific group of patients.

Section: Discussionmentioning

confidence: 81%

Recent Trends in Management of Pancreatic Pseudocysts

Santos¹,

Murayama²,

Nguyen³

et al. 1993

“…However, some studies suggested observation for selected patients with asymptomatic pseudocysts [15,16,17]. Nevertheless, most studies define acute and chronic pseudocysts but do not differentiate between acute and chronic pancreatitis [18, 19]. In order to achieve comparable data, we focused our analysis on 206 patients with chronic pancreatitis and pseudocysts in the pancreatic head who were operated with resection or drainage procedure.…”

Section: Discussionmentioning

confidence: 99%

Pseudocyst Treatment in Chronic Pancreatitis – Surgical Treatment of the Underlying Disease Increases the Long-Term Success

Schultze-Seemann

Siech

Beger³

2005

Background: For reasons of persisting controversies concerning indications for surgery, we evaluated chronic pancreatitis patients following pancreatic head resection or drainage procedure for pseudocysts located in the pancreatic head. Material and Methods: 206 patients (166 male, 40 female) with chronic pancreatitis and pseudocysts in the pancreatic head were operated between April 1982 and July 2001. 169 patients (82%) were treated with the duodenum-preserving pancreatic head resection, a pseudocyst-jejunostomy was performed in 37 patients (18%). Results: The hospital mortality was 0.4%. The late mortality was 19% in a median follow-up of 7.3 years. The rate of patients with complete relief of pain was significantly higher after resection compared to drainage procedure in the long-term follow-up (94 vs. 75%; p = 0.003). With regard to recurrence of pseudocysts, patients had an elevated rate of reoperations following drainage procedure (13 vs. 1%; p = 0.008). The endocrine function was significantly better preserved in patients of the drainage group compared to the resection group (no diabetes 67 vs. 35%, p < 0.01). Conclusion: The resection has, compared to drainage procedures alone, the advantage of low recurrence rate of pseudocysts and a high rate of pain-free patients in the long-term follow-up. However, the risk of diabetes is increased in the resection group.

“…Controversy exists regarding management of pseudocysts associated with chronic pancreatitis and indeed, most publications on pancreatic pseudocysts have not concentrated on those associated with chronic pancreatitis as distinct from pseu docysts developing in patients with acute pancreatitis [1,2]. Not only has differentiation in some series between acute or chronic pseudocysts occurring in association with acute or chronic pancreatitis not been clearly defined, but the implications of pseudocyst development in patients with chronic pancreatitis has not been clearly identified.…”

Section: Introductionmentioning

confidence: 99%

“…Preoperative cytology or histology was rarely available. Special attention was directed to differentiating pseudocysts in chronic pancreatitis from those associated with acute disease [1,2,5,6], Patients with pseudo cysts associated with acute pancreatitis were excluded from the study.…”

Section: Introductionmentioning

confidence: 99%

Complications of Chronic Pancreatitis

Seiler¹,

Boss²,

Czerniak³

et al. 1997

In order to define the risk factors resulting in morbidity and mortality, 154 patients referred to a surgical clinic because of suspected complications of chronic pancreatitis were studied. Pain was significantly more common (p = 0.006) in the presence of pseudocysts. The most important prognostic risk factor in chronic pancreatitis was found to be pseudocyst formation showing a significantly higher incidence of vascular complications (p = 0.0006), gastrointestinal symptoms (p = 0.003) and fistula formation (p = 0.04) when compared to patients without pseudocyst who showed a significantly higher incidence of cholestasis only (p = 0.002). The mortality rate in the pseudocyst group (7.1 %) was 4 times higher than that in the nonpseudocyst group (1.8%). The triad of a history of alcohol consumption, male gender and pseudocyst formation, occurring in 59 patients (38%), was associated with a 8.5% mortality rate.