Evaluating the Revised International Consensus Guidelines for Management of Pancreatic Cysts

Abstract

Introduction: The aim of this study is to compare the recently proposed 2012 International Consensus Guidelines (Fukuoka criteria) for the management of pancreatic cysts with the previous 2006 guidelines (Sendai criteria). Methods: A 5-year retrospective chart review between August 2007 and August 2012 was performed on patients who underwent surgery after meeting Sendai critera for a pancreatic cyst at a single tertiary academic center. Relevant clinical variables, cyst characteristics, and pathology results were collected to determine the presence of any high-risk stigmata, worrisome features, or alarming EUS findings. Results: Of the 125 eligible patients, 14 patients were excluded from the final analysis because of inadequate data. Among the remaining 111 patients, 14 patients had either adenocarcinoma (N=6) or high-grade dysplastic mucinous lesions (N=8). Using Fukuoka criteria, all of these lesions would have met criteria for surgical resection. Fewer surgeries would have been performed (N=51; 46%) compared to the Sendai criteria, of which 22 (20%) were found to be non-mucinous cysts. Seven MCNs, 3 mixed IPMNs, and 1 cystic neuroendocrine tumor would have been followed rather than resected. Conclusion: Application of the Fukuoka criteria to previously positive Sendai criteria cases results significantly in fewer surgeries without missing cases involving adenocarcinoma or high-grade dysplasia.Table 1