Extended surveillance among low-risk pancreatic cysts leads to fewer progression to advanced neoplasia

Low-risk branch duct intraductal papillary mucinous neoplasms (BD-IPMN lacking worrisome features (WF) and high-risk stigmata (HRS)), warrant surveillance. However, their optimal duration warrants further investigation, especially among cysts with initial five years of size stability. Researchers aim to systematically review the surveillance of low-risk BD-IPMNs and investigate the incidence of WF/HRS and advanced neoplasia: high-grade dysplasia and pancreatic cancer during the initial

A systematic search (CRD42020117120) identified studies investigating long-term IPMN surveillance outcomes of low-risk IPMN among Cochrane Library, Embase, Google Scholar, Ovid Medline, PubMed, Scopus, and Web of Science, from inception until July 9, 2021. The outcomes included incidence of WF/HRS and advanced neoplasia, disease-specific mortality, and surveillance-related harm (expressed as % patient-years). The meta-analysis relied on time-to-event plots and utilized a random-effects model.

Results:

Forty-one eligible studies underwent systematic review, and eighteen studies were meta-analyzed. The pooled incidence of WF/HRS among low-risk BD-IPMNs during initial and extended surveillance was 2.2% patient-years, respectively. In contrast, the incidence of advanced neoplasia was 0.6% and 1.0% patient-years, respectively. The pooled incidence of disease-specific mortality during initial and extended surveillance were 0.3% and 0.6% patient-years, respectively. Among BD-IPMNs with initial size stability, extended surveillance had WF/HRS and advanced neoplasia incidence of 1.9% and 0.2% patient-years.

A key finding of this study is a lower incidence of advanced neoplasia during extended surveillance among low-risk, stable-sized BD-IPMNs. However, the survival benefit of surveillance among this population warrants further exploration through high-quality studies before recommending surveillance cessation with certainty.

Reference:

The benefit of extended surveillance of low-risk pancreatic cysts after five-year stability: a systematic review and meta-analysis by Ankit Chhoda, et al. published in the Clinical Gastroenterology and Hepatology

DOI: https://doi.org/10.1016/j.cgh.2022.04.025