Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 11/2014

01-10-2014 | Pancreatic Tumors

Role of a Multidisciplinary Clinic in the Management of Patients with Pancreatic Cysts: A Single-Center Cohort Study

Authors: Anne Marie Lennon, MD, PhD, Lindsey L. Manos, PA-C, Ralph H. Hruban, MD, Syed Z. Ali, MD, Elliot K. Fishman, MD, Ihab R. Kamel, MD, Siva P. Raman, MD, Atif Zaheer, MD, Susan Hutfless, PhD, Ashley Salamone, MSN CRNP, Vandhana Kiswani, MD, Nita Ahuja, MD, Martin A. Makary, MD, Matthew J. Weiss, MD, Kenzo Hirose, MD, Michael Goggins, MD, Christopher L. Wolfgang, MD, PhD, FACS

Published in: Annals of Surgical Oncology | Issue 11/2014

Login to get access

Abstract

Background

Incidental pancreatic cysts are common, a small number of which are premalignant or malignant. Multidisciplinary care has been shown to alter management and improve outcomes in many types of cancers, but its role has not been examined in patients with pancreatic cysts. We assessed the effect of a multidisciplinary pancreatic cyst clinic (MPCC) on the diagnosis and management of patients with pancreatic cysts.

Methods

The referring institution and MPCC diagnosis and management plan were recorded. Patient were placed into one of five categories—no, low, intermediate, or high risk of malignancy within the cyst, and malignant cyst—on the basis of their diagnosis. Patients were assigned one of four management options: surveillance, surgical resection, further evaluation, or discharge with no further follow-up required. The MPCC was deemed to have altered patient care if the patient was assigned a different risk or management category after the MPCC review.

Results

Referring institution records were available for 262 patients (198 women; mean age 62.7 years), with data on risk category available in 138 patients and management category in 225. The most common diagnosis was branch duct intraductal papillary mucinous neoplasm. MPCC review altered the risk category in 11 (8.0%) of 138 patients. The management category was altered in 68 (30.2%) of 225 patients. Management was increased in 52 patients, including 22 patients who were recommended surgical resection. Management was decreased in 16 patients, including 10 who had their recommendation changed from surgery to surveillance.

Conclusions

MPCC is helpful and alters the management over 30% of patients.
Appendix
Available only for authorised users
Literature
1.
2.
Tanaka M, Fernandez-Del Castillo C, Adsay V, et al. International consensus guidelines 2012 for the management of IPMN and MCN of the pancreas. Pancreatology. 2012;12:183–97.PubMedCrossRef
3.
Tanaka M, Chari S, Adsay V, et al. International consensus guidelines for management of intraductal papillary mucinous neoplasms and mucinous cystic neoplasms of the pancreas. Pancreatology. 2006;6:17–32.PubMedCrossRef
4.
Valsangkar NP, Morales-Oyarvide V, Thayer SP, et al. 851 resected cystic tumors of the pancreas: a 33-year experience at the Massachusetts General Hospital. Surgery. 2012;152(3 Suppl 1):S4–12.PubMedCrossRefPubMedCentral
5.
Back MF, Ang EL, Ng WH, et al. Improvements in quality of care resulting from a formal multidisciplinary tumour clinic in the management of high-grade glioma. Ann Acad Med Singapore. 2007;36:347–51.PubMed
6.
Gabel M, Hilton NE, Nathanson SD. Multidisciplinary breast cancer clinics. Do they work? Cancer. 1997;79:2380–4.PubMedCrossRef
7.
Petty JK, Vetto JT. Beyond doughnuts: tumor board recommendations influence patient care. J Cancer Educ. 2002;17:97–100.PubMed
8.
Pawlik TM, Laheru D, Hruban RH, et al. Evaluating the impact of a single-day multidisciplinary clinic on the management of pancreatic cancer. Ann Surg Oncol. 2008;15:2081–8.PubMedCrossRefPubMedCentral
9.
Berrington de Gonzalez A, Mahesh M, Kim KP, et al. Projected cancer risks from computed tomographic scans performed in the United States in 2007. Arch Intern Med. 2009;169:2071–7.PubMedCrossRef
10.
Buscaglia JM, Shin EJ, Giday SA, et al. Awareness of guidelines and trends in the management of suspected pancreatic cystic neoplasms: survey results among general gastroenterologists and EUS specialists. Gastrointest Endosc. 2009;69:813–20.PubMedCrossRef
11.
de Wilde RF, Besselink MG, van der Tweel I, et al. Impact of nationwide centralization of pancreaticoduodenectomy on hospital mortality. Br J Surg. 2012;99:404–10.PubMedCrossRef
12.
Winter JM, Cameron JL, Campbell KA, et al. 1423 pancreaticoduodenectomies for pancreatic cancer: A single-institution experience. J Gastrointest Surg. 2006;10:1199–210.PubMedCrossRef
13.
Sainani NI, Saokar A, Deshpande V, Fernandez-del Castillo C, Hahn P, Sahani DV. Comparative performance of MDCT and MRI with MR cholangiopancreatography in characterizing small pancreatic cysts. AJR Am J Roentgenol. 2009;193:722–31.PubMedCrossRef
14.
Visser BC, Yeh BM, Qayyum A, Way LW, McCulloch CE, Coakley FV. Characterization of cystic pancreatic masses: relative accuracy of CT and MRI. AJR. Am J Roentgenol. 2007;189:648–56.PubMedCrossRef
15.
Brugge WR, Lewandrowski K, Lee-Lewandrowski E, et al. Diagnosis of pancreatic cystic neoplasms: a report of the cooperative pancreatic cyst study. Gastroenterology. 2004;126:1330–6.PubMedCrossRef
16.
Park WG, Mascarenhas R, Palaez-Luna M, et al. Diagnostic performance of cyst fluid carcinoembryonic antigen and amylase in histologically confirmed pancreatic cysts. Pancreas. 2011;40:42–5.PubMedCrossRefPubMedCentral
17.
Maire F, Voitot H, Aubert A, et al. Intraductal papillary mucinous neoplasms of the pancreas: performance of pancreatic fluid analysis for positive diagnosis and the prediction of malignancy. Am J Gastroenterol. 2008;103:2871–7.PubMedCrossRef
18.
Al-Haddad M, Dewitt J, Sherman S, et al. Performance characteristics of molecular (DNA) analysis for the diagnosis of mucinous pancreatic cysts. Gastrointest Endosc. 2014;79:79–87.PubMedCrossRef
19.
Wu J, Jiao Y, Dal Molin M, et al. Whole-exome sequencing of neoplastic cysts of the pancreas reveals recurrent mutations in components of ubiquitin-dependent pathways. Proc Natl Acad Sci U S A. 2011;108:21188–93.PubMedCrossRefPubMedCentral
20.
Wu J, Matthaei H, Maitra A, et al. Recurrent GNAS mutations define an unexpected pathway for pancreatic cyst development. Sci Transl Med. 2011;3:92ra66.PubMedCrossRefPubMedCentral
21.
Correa-Gallego C, Do R, Lafemina J, et al. Predicting dysplasia and invasive carcinoma in intraductal papillary mucinous neoplasms of the pancreas: development of a preoperative nomogram. Ann Surg Oncol. 2013;20:4348–55.PubMedCrossRef
Metadata
Title
Role of a Multidisciplinary Clinic in the Management of Patients with Pancreatic Cysts: A Single-Center Cohort Study
Authors
Anne Marie Lennon, MD, PhD
Lindsey L. Manos, PA-C
Ralph H. Hruban, MD
Syed Z. Ali, MD
Elliot K. Fishman, MD
Ihab R. Kamel, MD
Siva P. Raman, MD
Atif Zaheer, MD
Susan Hutfless, PhD
Ashley Salamone, MSN CRNP
Vandhana Kiswani, MD
Nita Ahuja, MD
Martin A. Makary, MD
Matthew J. Weiss, MD
Kenzo Hirose, MD
Michael Goggins, MD
Christopher L. Wolfgang, MD, PhD, FACS
Publication date
01-10-2014
Publisher
Springer US
Published in
Annals of Surgical Oncology / Issue 11/2014
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-014-3739-x

Other articles of this Issue 11/2014

Annals of Surgical Oncology 11/2014 Go to the issue

Breast Oncology

Survival Analysis of Contralateral Prophylactic Mastectomy: A Question of Selection Bias

Gastrointestinal Oncology

Impact of External-Beam Radiation Therapy on Outcomes Among Patients with Resected Gastric Cancer: A Multi-institutional Analysis

Breast Oncology

Predicting the Extent of Nodal Disease in Early-Stage Breast Cancer

Endocrine Tumors

Quality of Life is Modestly Improved in Older Patients with Mild Primary Hyperparathyroidism Postoperatively: Results of a Prospective Multicenter Study

Breast Oncology

The Promise of Axillary Imaging in Individualized Surgical Management of Breast Cancer Patients: Another Step Forward

Gastrointestinal Oncology

Adjuvant Therapy for Gastric Cancers: More Answers or More Questions?