TY - JOUR
T1 - Surveillance for Presumed BD-IPMN of the Pancreas
T2 - Stability, Size, and Age Identify Targets for Discontinuation
AU - Marchegiani, Giovanni
AU - Pollini, Tommaso
AU - Burelli, Anna
AU - Han, Youngmin
AU - Jung, Hye-Sol
AU - Kwon, Wooil
AU - Rocha Castellanos, Dario Missael
AU - Crippa, Stefano
AU - Belfiori, Giulio
AU - Arcidiacono, Paolo Giorgio
AU - Capurso, Gabriele
AU - Apadula, Laura
AU - Zaccari, Piera
AU - Noia, José Lariño
AU - Gorris, Myrte
AU - Busch, Olivier
AU - Ponweera, Arachchige
AU - Mann, Kulbir
AU - Demir, Ihsan Ekin
AU - Phillip, Veit
AU - Ahmad, Nuzhat
AU - Hackert, Thilo
AU - Heckler, Max
AU - Lennon, Anne Marie
AU - Afghani, Elham
AU - Vallicella, Davide
AU - Dall'Olio, Tommaso
AU - Nepi, Angelica
AU - Vollmer, Charles M.
AU - Friess, Helmut
AU - Ghaneh, Paula
AU - Besselink, Marc
AU - Falconi, Massimo
AU - Bassi, Claudio
AU - Goh, Brian Kim-Poh
AU - Jang, Jin-Young
AU - Fernández-del Castillo, Carlos
AU - Salvia, Roberto
N1 - Funding Information: Funding The Department of General and Pancreatic Surgery at the University of Verona received funding from the Italian Ministry of Health (Grant FIMP-CUP J38D19000690001 ). Publisher Copyright: © 2023 AGA Institute
PY - 2023/10
Y1 - 2023/10
N2 - Background & Aims: Currently, most patients with branch duct intraductal papillary mucinous neoplasms (BD-IPMN) are offered indefinite surveillance, resulting in health care costs with questionable benefits regarding cancer prevention. This study sought to identify patients in whom the risk of cancer is equivalent to an age-matched population, thereby justifying discontinuation of surveillance. Methods: International multicenter study involving presumed BD-IPMN without worrisome features (WFs) or high-risk stigmata (HRS) at diagnosis who underwent surveillance. Clusters of individuals at risk for cancer development were defined according to cyst size and stability for at least 5 years, and age-matched controls were used for comparison using standardized incidence ratios (SIRs) for pancreatic cancer. Results: Of 3844 patients with presumed BD-IPMN, 775 (20.2%) developed WFs and 68 (1.8%) HRS after a median surveillance of 53 (interquartile range 53) months. Some 164 patients (4.3%) underwent surgery. Of the overall cohort, 1617 patients (42%) remained stable without developing WFs or HRS for at least 5 years. In patients 75 years or older, the SIR was 1.12 (95% CI, 0.23–3.39), and in patients 65 years or older with stable lesions smaller than 15 mm in diameter after 5 years, the SIR was 0.95 (95% CI, 0.11–3.42). The all-cause mortality for patients who did not develop WFs or HRS for at least 5 years was 4.9% (n = 79), and the disease-specific mortality was 0.3% (n = 5). Conclusions: The risk of developing pancreatic malignancy in presumed BD-IPMN without WFs or HRS after 5 years of surveillance is comparable to that of the general population depending on cyst size and patient age. Surveillance discontinuation could be justified after 5 years of stability in patients older than 75 years with cysts <30 mm, and in patients 65 years or older who have cysts ≤15 mm.
AB - Background & Aims: Currently, most patients with branch duct intraductal papillary mucinous neoplasms (BD-IPMN) are offered indefinite surveillance, resulting in health care costs with questionable benefits regarding cancer prevention. This study sought to identify patients in whom the risk of cancer is equivalent to an age-matched population, thereby justifying discontinuation of surveillance. Methods: International multicenter study involving presumed BD-IPMN without worrisome features (WFs) or high-risk stigmata (HRS) at diagnosis who underwent surveillance. Clusters of individuals at risk for cancer development were defined according to cyst size and stability for at least 5 years, and age-matched controls were used for comparison using standardized incidence ratios (SIRs) for pancreatic cancer. Results: Of 3844 patients with presumed BD-IPMN, 775 (20.2%) developed WFs and 68 (1.8%) HRS after a median surveillance of 53 (interquartile range 53) months. Some 164 patients (4.3%) underwent surgery. Of the overall cohort, 1617 patients (42%) remained stable without developing WFs or HRS for at least 5 years. In patients 75 years or older, the SIR was 1.12 (95% CI, 0.23–3.39), and in patients 65 years or older with stable lesions smaller than 15 mm in diameter after 5 years, the SIR was 0.95 (95% CI, 0.11–3.42). The all-cause mortality for patients who did not develop WFs or HRS for at least 5 years was 4.9% (n = 79), and the disease-specific mortality was 0.3% (n = 5). Conclusions: The risk of developing pancreatic malignancy in presumed BD-IPMN without WFs or HRS after 5 years of surveillance is comparable to that of the general population depending on cyst size and patient age. Surveillance discontinuation could be justified after 5 years of stability in patients older than 75 years with cysts <30 mm, and in patients 65 years or older who have cysts ≤15 mm.
KW - Pancreas
KW - Pancreatic Cancer
KW - Pancreatic Cyst
KW - Surveillance Discontinuation
UR - http://www.scopus.com/inward/record.url?scp=85169808891&partnerID=8YFLogxK
U2 - https://doi.org/10.1053/j.gastro.2023.06.022
DO - https://doi.org/10.1053/j.gastro.2023.06.022
M3 - Article
C2 - 37406887
SN - 0016-5085
VL - 165
SP - 1016-1024.e5
JO - Gastroenterology
JF - Gastroenterology
IS - 4
ER -