Cystic Lesions of the Pancreas

Pancreatic cystic lesions (PCLs) are commonly identified incidentally. Prevalence of PCLs increases with age and are therefore of specific importance to the geriatric population. Currently, the only definitive treatment for PCLs is surgical resection. Intraductal papillary mucinous neoplasms (IPMNs) are one of the most commonly encountered PCLs in clinical practice. Although the majority of IPMNs do not harbor invasive cancer when initially detected their malignant potential often creates a diagnostic and therapeutic dilemma. Before management decisions can be made, it is important to characterize a PCL using a combination of clinical and imaging features to assess the risk of incident or future malignancy. After a PCL has been appropriately characterized, some would warrant immediate surgical resection. In other PCLs, a management strategy ranging from no follow-up to periodic imaging surveillance must be implemented. If surgical resection is warranted, morbidity and mortality related to surgery and postoperative quality of life must be discussed with the patient to facilitate a shared decision. This chapter outlines the classification of PCLs and diagnostic and management approaches that will enable the reader to develop an evidence-based care plan for geriatric patients with PCLs.