Research on the classification of pancreatic pseudocysts based on individualized treatment protocols

To investigate the clinical efficacy of various treatment modalities for pancreatic pseudocysts (PPC), analyze the associations between clinical presentations, imaging characteristics, and therapeutic choices, and develop a clinically relevant classification system based on integrated clinical-imaging features to guide individualized and precise management. A retrospective analysis was performed on clinical data from 187 patients with PPC admitted to Qinghai Provincial People’s Hospital between January 2016 to June 2024. Patients were categorized into four groups according to treatment modality: conservative management (n = 75), percutaneous catheter drainage (PCD; n = 47), endoscopic drainage (n = 28), and laparoscopic drainage (n = 37). Outcomes including clinical presentation, imaging findings, treatment efficacy, complication rates, length of hospital stay, medical costs, and follow-up results were systematically compared across groups. A classification framework for PPC was developed through comprehensive data analysis and stratification. Strong association between imaging characteristics and treatment selection: Patients with cyst diameter ≥ 6 cm (χ²= 93.970, P < 0.001), duration of cyst formation ≥ 6 weeks (χ² = 110.95, P < 0.001), and presence of a mature cyst wall (χ² = 128.39, P < 0.001) were significantly more likely to receive endoscopic or laparoscopic intervention. The mean cyst diameter in the conservative group was markedly smaller (44.0 mm vs. 85.0–104.0 mm, P < 0.001). 2.Significant differences in treatment outcomes and complications: Conservative management achieved a cure rate of 96.0%, but was primarily indicated for small cysts (< 6 cm). The PCD group had an infection complication rate of 8.5%. For large cysts, endoscopic and laparoscopic drainage demonstrated comparable efficacy (cure rates: 91.7%–92.8%), though the laparoscopic approach incurred significantly higher medical costs (35,006 yuan vs. 24,273 yuan, P < 0.001). 3.Development of a novel classification system: Based on cyst size, duration of formation, cyst wall maturity, and anatomical relationship with surrounding structures, PPC were classified into four main types and seven subtypes. Type I (< 6 cm, < 6 weeks) is recommended for conservative management; Type II (≥ 6 cm, poor general condition) is best managed with PCD; Types III and IV (≥ 6 cm, mature cysts) are candidates for either endoscopic or laparoscopic drainage depending on anatomical feasibility. The treatment of PPC requires individualized selection based on imaging features. The new classification system can effectively guide clinical decisions and improve treatment accuracy.