Identification of pancreatic cystic lesions has become increasingly common due to improved resolution and increased utilization of cross-sectional imaging. However, there are many types of pancreatic cysts, each with varying degrees of malignant potential. In this episode from the HPB team at Behind the Knife, listen in as we discuss the clinical presentation, diagnostic work-up, and management strategies for various pancreatic cysts: Pseudocysts, Serous Cystadenomas, Mucinous Cystic Neoplasms, and IPMNs, amongst others.

Hosts
Anish J. Jain MD (@anishjayjain) is a current PGY4 General Surgery resident at Stanford University and a former T32 Research Fellow at the University of Texas MD Anderson Cancer Center.

Jon M. Harrison MD is a Hepatobiliary & Pancreatic (HPB) surgeon at the Massachusetts General Hospital in Boston, MA and a former HPB Surgery fellow at Stanford University.

Learning Objectives
· Develop an understanding of the clinical presentation, diagnostic work-up, and treatment of benign pancreatic cysts
· Develop an understanding of the clinical presentation, diagnostic work-up, and treatment of pre-malignant pancreatic cysts
· Develop an understanding of when surveillance is appropriate for management of pancreatic cysts, and the criteria involved in making that determination
· Develop an understanding of the prognostic utility of PancSeq for IPMNs

References:

Paniccia A, Polanco PM, Boone BA, et al. Prospective, Multi-Institutional, Real-Time Next-Generation Sequencing of Pancreatic Cyst Fluid Reveals Diverse Genomic Alterations That Improve the Clinical Management of Pancreatic Cysts. Gastroenterology. 2023 Jan;164(1):117-133.e7.
- PubMed Link: https://pubmed.ncbi.nlm.nih.gov/36209796/
Ohtsuka T, Fernandez-Del Castillo C, Furukawa T, et al. International evidence-based Kyoto guidelines for the management of intraductal papillary mucinous neoplasm of the pancreas. Pancreatology. 2024 Mar;24(2):255-270.
- PubMed Link: https://pubmed.ncbi.nlm.nih.gov/38182527/
Zelga P, Hernandez-Barco YG, Qadan M, et al. Number of Worrisome Features and Risk of Malignancy in Intraductal Papillary Mucinous Neoplasm. J Am Coll Surg. 2022 Jun 1;234(6):1021-1030.
- PubMed Link: https://pubmed.ncbi.nlm.nih.gov/35703792/
Ciprani D, Weniger M, Qadan M, et al. Risk of malignancy in small pancreatic cysts decreases over time. Pancreatology. 2020 Sep;20(6):1213-1217.
- PubMed Link: https://pubmed.ncbi.nlm.nih.gov/32819844/

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Clinical Challenges in Hepatobiliary Surgery: Pancreatic Cysts