Selected management of pancreatic pseudocysts: Operative versus expectant management

Background. The aim of this study was to determine if nonoperative, noninterventional expectant management of pancreatic pseudocysts is warranted in selected patients. Methods. From 1980 to 1985, 114 patients with the diagnosis of pancreatic pseudocyst were evaluated. Results. Forty-six patients underwent primary operative therapy, with 13% undergoing emergency operations for pseudocyst-related complications. Although no operative deaths occurred, significant morbidity occurred in 26% of patients (emergency operations, 67%; elective procedures, 10%). The remaining 68 patients were initially treated selectively with a nonoperative, expectant approach. Severe, life-threatening complications in this group followed up for a mean of 46 months occurred in only 6 patients (9%); 19 patients eventually underwent elective operation directed at either the pseudocyst or other complications related to pancreatitis. Overall, in patients managed by a nonoperative approach, resolution of the pseudocyst occurred in 57% of the 24 patients with satisfactory radiographic follow-up, with 38% resolving more than 6 months after diagnosis. Although patients eventually undergoing operation tended to have larger pancreatic pseudocysts than the patients managed successfully nonoperatively (6.9 vs 4.9 cm), no serious complications occurred in seven patients with pancreatic pseudocysts greater than 10 cm who were treated expectantly. Conclusions. A nonoperative, noninterventional, expectant approach is warranted in the management of selected patients with pancreatic pseudocysts.