Pancreatic Cystic Lesions in the Older Patient: A Review of Clinical Guidelines and Management.

Abstract

Purpose of review: The purpose of this review is to summarize key features of the epidemiology of pancreatic cystic lesions (PCLs), highlight the most common PCLs encountered in clinical practice, review relevant guideline recommendations, and briefly introduce innovative new diagnostic and therapeutic technologies in the field, particularly as they relate to the care of elderly patients.

Recent findings: While CT and MRI are mainstays of diagnostic studies for PCLs, endoscopic ultrasound with fine-needle aspiration and cyst fluid analysis can considerably improve the accuracy of presurgical diagnosis. Surgical interventions remain associated with considerable morbidity. While surveillance of certain lesions is appropriate, surveillance is associated with considerable monetary costs and can cause undue anxiety for patients. There remains uncertainty regarding the optimal management strategy of PCLs given the lack of high-quality evidence to guide recommendations. Management decisions for PCLs, be it for surveillance, surgical resection, or invasive diagnostics, should be highly personalized and based on the unique risk-benefit analysis for a given lesion. Especially in elderly populations, physicians should have informed conversations with patients regarding the likelihood of a given PCL meaningfully affecting quality-of-life or life-expectancy.