Long‐term surveillance of branch‐duct intraductal papillary mucinous neoplasms without worrisome or high‐risk features

Abstract

AbstractIntroductionLong‐term data evaluating clinical outcomes in patients with branch‐duct Intraductal papillary mucinous neoplasms (BD‐IPMN) without high‐risk stigmata (HRS) or worrisome features (WF) remain limited.MethodsThis observational cohort study included all patients diagnosed with BD‐IPMN without HRS or WF between 2003 and 2019 who were enrolled in a prospective surveillance program. Time‐to‐progression analysis was performed using a cumulative incidence function plot and survival analysis was conducted using Kaplan–Meier.ResultsThe median follow‐up time for the 267 patient cohort was 44.5 months (interquartile range [IQR]: 24.1–72.2). Radiographic cyst growth was observed in 123 (46.1%) patients; 65 (24.3%) patients progressed to WF/HRS. Twenty‐six (9.7%) patients were selected for resection during surveillance: 21 (80.8%) WF, 4 (15.4%) HRS; 1 (3.9%) transformed to mixed‐duct. Of all the patients who underwent resection, 5 (19.2%) had adenocarcinoma, and 1 (3.8%) had carcinoma‐in‐situ. The probability of any radiographic progression was 21.3% (5‐year) and 51.3% (10‐year). For the entire cohort, there was 1.1% mortality secondary to pancreatic adenocarcinoma and 8.2% all‐cause mortality. The 5‐year overall survival rate was 91.5%, and at 10 years, 81.5%.ConclusionApproximately one in four patients with nonworrisome BD‐IPMN have progression to WF/HRS stigmata during surveillance. However, the risk of malignant transformation remains low. Surveillance strategy remains prudent in this patient population.