Investigators have called into question the health benefit of extended surveillance for patients whose pancreatic cysts have not changed size for at least 5 years and had no worrisome features, according to a new study published by Chhoda et al in Clinical Gastroenterology and Hepatology.
Background
Low-risk branch duct intraductal papillary mucinous neoplasms (IPMN) are the most common precancerous type of mucinous pancreatic cysts and, once identified, require regular imaging surveillance. However, the consensus is still forming around how long the surveillance period should last.
"Pancreatic cysts are extremely common and often require regular imaging surveillance [as a result of] their variable risk of pancreatic cancer,” explained senior study author James Farrell, MBChB, Professor of Medicine and Surgery in the Department of Digestive Diseases at the Yale School of Medicine and Director of the Yale Center for Pancreatic Diseases. “Controversy exists with current guidelines about which patients should consider stopping surveillance. This … study highlights the persistent risk of malignancy even after 5 or 10 years of surveillance,” he added.
Study Methods and Results
In a systematic review, the investigators examined the data from 41 IPMN surveillance studies and compared the incidence of worrisome features and high-risk stigmata as well as advanced neoplasia during the initial surveillance period (the first 5 years after initial observation) and extended surveillance period (after 5 years).
The investigators found that the risk of worrisome features and high-risk stigmata rose from 2.2% patient-years in the initial surveillance period to 2.9% patient-years in the extended surveillance period. Further, the risk of advanced neoplasia rose from 0.6% patient-years to 1.0% patient-years between the initial and extended surveillance periods. However, among patients whose cysts had 5 years of size stability, extended surveillance showed a 1.9% patient-years risk of worrisome features and high-risk stigmata, and a 0.2% patient-years risk of advanced neoplasia.
Conclusions
The investigators underscored that for patients whose cyst size remained stable for 5 years or more, extended surveillance may not offer a worthwhile survival benefit. However, more studies may be needed to validate whether surveillance cessation should be recommended.
“A greater understanding of the biology and natural history of progression of pancreatic cysts is needed to improve our surveillance strategies—in order to make more informed decisions about which patients to follow more closely and about which patients we can decrease surveillance,” Dr. Farrell concluded.
Disclosure: For full disclosures of the study authors, visit cghjournal.org.
