Clinicians at the Mass General CIST Center diagnose, treat and monitor patients with pancreatic cystic lesions.

Whipple

Surgical Approaches to Cysts

The Cyst Imaging Surveillance and Treatment (CIST) Center includes expert surgeons who specialize in the excision of pancreatic cysts.

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Blake 4
55 Fruit Street
Boston, MA 02114
617-724-0578

The surgical management of pancreatic cysts was pioneered by Dr. Andrew Warshaw at MGH nearly 40 years ago. Surgical excision of cysts requires that an entire segment of the pancreas be resected and not just the cyst alone. The type of resection is dependent upon the location of the cyst. A resection of a cyst in the head of the pancreas involves a Whipple resection.

MGH performs more Whipple resections than any other hospital in New England. Cysts located in the body and tail of the pancreas require a distal pancreatectomy, which is often done laparoscopically. For cysts located in the neck or proximal body of the pancreas, a middle pancreatectomy, an operation that was pioneered at MGH, can be done. Compared to the alternative of a distal pancreatectomy, a middle pancreatectomy is much less likely to lead to diabetes or pancreatic exocrine insufficiency. 

Surgical resection margins are evaluated by an expert pancreatic pathologist at the time of the operation to ensure that no concerning disease is left behind. Resected lesions are carefully analyzed by pathologists to determine the type of cyst, the presence of malignancy and the stage of malignancy. One of the major developments in the classification of IPMN has been lead by a MGH pathologist, Dr. Mari Mino-Kenudson. There are four tissue types of IPMN and the type of IPMN has a major impact on the behavior and aggressiveness of malignant IPMNs.