The faith of non-surveilled pancreatic cysts: a bicentric retrospective study

• Published in: European journal of surgical oncology 2022-01, Vol.48 (1), p.89-94
• Main Authors: Surci, N., Marchegiani, G., Andrianello, S., Pollini, T., Mühlbacher, J., Jomrich, G., Richwien, P., Tamandl, D., Schindl, M., Bassi, C., Salvia, R., Sahora, K.
• Format: Article
• Language: English
• Subjects: Adenoma - pathology; Aged; Aged, 80 and over; Carcinoma - epidemiology; Carcinoma - pathology; Carcinoma, Pancreatic Ductal - epidemiology; Carcinoma, Pancreatic Ductal - pathology; Disease Progression; Female; Humans; Incidence; Incidental Findings; IPMN; Male; Middle Aged; Neoplasms, Cystic, Mucinous, and Serous - epidemiology; Neoplasms, Cystic, Mucinous, and Serous - pathology; Pancreas; Pancreatic cancer; Pancreatic Cyst - pathology; Pancreatic cysts; Pancreatic Intraductal Neoplasms - pathology; Pancreatic Neoplasms - epidemiology; Pancreatic Neoplasms - pathology; Retrospective Studies; Surgery; Surveillance; Watchful Waiting
• ISSN: 0748-7983; 1532-2157
• DOI: 10.1016/j.ejso.2021.06.007

Incidental discovery of pancreatic cystic neoplasms (PCLs) is a common and steadily increasing occurrence. The aim of this study was to investigate a cohort of patients presenting with incidentally detected PCLs which were not included in a surveillance protocol, and to compare their risk of malignant evolution with that of systematically surveilled lesions. A population of PCLs which did not receive surveillance over a period >10 years (population A) was selected at the Medical University of Vienna. A group of “low risk” branch duct intraductal papillary mucinous neoplasm ≤15 mm in size upon diagnosis undergoing a regular follow-up of at least 5 years at the University of Verona was selected as control (population B). The incidence of pancreatic cancer (PC), cumulative risk of PC and disease-specific survival were compared. Overall, 376 patients with non-surveilled PCLs were included in study group A and compared to 299 patients in group B. This comparison resulted in similar incidence rates of PC (1.6% vs 1.7%, p = 0.938), a strong similarity in terms of disease-specific mortality rates (1.3% vs 0.3%, p = 0.171) and the 5- and 10-year cumulative risk of PC (≅ 1% and 2%, p = 0.589) and DSS (≅ 100% and 98%, p = 0.050). The “price to pay” for a negligence-based policy in the population of non-surveilled PCLs was reasonable, and the incidence of PC was comparable to that reported for a population of low-risk cysts enrolled to a standardized surveillance protocol.