Pancreatic Cysts : Treatment

Pictured: Ronald DeMatteo Ronald DeMatteo, Head of the Division of General Surgical Oncology, is part of our experienced surgical team.

At Memorial Sloan Kettering, we make every effort to select the most-appropriate treatment for each patient, depending on whether a cyst is benign or precancerous, and whether it is causing symptoms such as pain or jaundice.

Surveillance

Many doctors routinely perform surgery to remove all pancreatic cysts because it is difficult to predict which ones will progress to cancer. Increasingly, doctors are questioning the value of performing pancreatic surgery on patients with small cysts that have a low risk of causing symptoms or becoming cancerous.

Over the past 15 years, surgeons at Memorial Sloan Kettering have rigorously investigated the safety and appropriateness of taking a more selective approach to operating on pancreatic cysts. Our doctors have found that surgery can be safely avoided for most patients with small, asymptomatic cysts that do not have a solid component commonly found in cancerous lesions.(1)

If diagnostic evidence strongly suggests that your pancreatic cyst is benign, we recommend periodic surveillance with imaging tests to monitor for any signs of progression. Our research has shown that surveillance is safe and appropriate for patients with smaller, asymptomatic pancreatic cysts.(2) We also recommend regular, ongoing surveillance for patients who had surgery to remove an IPMN, which can reoccur over time, and for those who did not have their entire pancreas removed. 

During your first two surveillance visits, you will meet with a surgeon and a gastroenterologist. Later, you will meet regularly with a nurse practitioner who works exclusively with the pancreatic care team.  

Surgery

Surgery may be recommended for patients with larger pancreatic cysts that cause symptoms or have other features that are suggestive of cancer progression. Depending on the location and size of the cyst, our doctors may use open surgery, laparoscopic surgery, or robot-assisted

surgery to completely remove the cyst and preserve as much of the pancreas as possible. No matter which surgical approach you and your doctor choose, our goals are to remove your entire pancreatic cyst and to preserve your digestive function.

Any type of pancreatic surgery can be a major operation. Many studies have confirmed that surgical outcomes are better for patients who are treated at a center that performs a higher volume of pancreas operations. Our surgeons have pioneered new techniques to reduce complications, making pancreatic surgery a safer operation for more people than ever before. We are also evaluating new drugs and techniques that can be used during pancreatic surgery to further reduce the risk of pancreatic fluid leakage and blood loss.

Depending on your scans and other diagnostic information, a pathologist may be present during the operation to look for signs that the disease has spread. Patients with invasive disease or other signs of cancer are immediately referred to a medical oncologist who specializes in treating pancreatic cancer. The medical oncologist will work with your surgeon and gastroenterologist to provide you with the best care possible.

Open Surgery

Whipple Procedure

The Whipple procedure, also called a pancreatoduodenectomy, is used to remove an intraductal papillary mucinous neoplasm (IPMN) or mucinous cystic neoplasm (MCN) that is located in the head (right portion) of the pancreas. In this procedure, the surgeon removes the head of the pancreas, part of the small intestine, the lower half of the bile duct, the surrounding lymph nodes, the gallbladder, and sometimes part of the stomach. When the stomach is left intact, this operation is called a pylorus-preserving Whipple procedure. The stomach, bile duct, and remaining pancreas are then joined to the small intestine so that digestive enzymes can mix with food.

Although this procedure is complex, it is safe and effective for many patients.

Distal Pancreatectomy

This procedure is used to remove an IPMN or MCN that is located in the tail (left portion) of the pancreas. The surgeon removes the tail and may also remove the spleen

Total Pancreatectomy

If diagnostic tests indicate that an IPMN has begun to spread throughout your pancreas, your surgeon may recommend removing the entire organ. This procedure may also involve removal of the gallbladder, part of the stomach, part of the small intestine, the lower half of the bile duct, the spleen, and nearby lymph nodes.

Minimally Invasive Surgical Techniques

Minimally invasive surgery for pancreatic cysts is performed through small incisions in the abdominal wall. It typically results in the least possible harm to the pancreas and surrounding organs and tissue.

This type of surgery has a number of potential benefits for patients, including fewer complications, less blood loss, a shorter hospital stay, and quicker recovery than conventional open surgery, which requires a larger incision.

Although minimally invasive surgery is not effective for all people with pancreatic cysts, it is an option for many, especially those who need less-extensive surgery. Surgeons at Memorial Sloan Kettering are experts in two types of minimally invasive surgery on the pancreas: laparoscopic surgery and robot-assisted surgery.

Laparoscopic Surgery

In laparoscopic surgery, the surgeon inserts a laparoscope — a thin, lighted tube with a camera on its tip — through a tiny incision. This approach can be used to remove pancreatic cysts and all or part of the pancreas. The laparoscope can also be used to reconstruct the digestive system.

Surgeons at Memorial Sloan Kettering conducted the largest single-institution study comparing laparoscopic surgery to open surgery for performing distal pancreatectomy. Our research showed that laparoscopic approaches can reduce blood loss and length of hospital stay compared with open surgery. 3

Robot-Assisted Surgery

Surgeons at Memorial Sloan Kettering also are experienced in performing a minimally invasive procedure known as robot-assisted laparoscopic pancreatic surgery.

Using a sophisticated device called the da Vinci® Surgical System, the surgeon performs the operation while seated at a console that has a viewing screen as well as hand, finger, and foot controls. The screen projects a magnified three-dimensional image of the pancreas and the surrounding area, allowing the surgeon to view the surgical site in fine anatomical detail. The surgeon uses the controls to move the robotic arms with much finer precision than would be possible with other surgical techniques.