Extended Surveillance Among Low-Risk Pancreatic Cysts Leads
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, especially among cysts with initial five years of size stability, warrants further investigation.

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 random-effects model.

Forty-one eligible studies underwent systematic review, and eighteen studies were meta-analyzed. Pooled incidence of WF/HRS among low-risk BD-IPMNs during initial and extended surveillance were 2.2% [95%CI:1.0%-3.7%] and 2.9% [95%CI:1.0%-5.7%] patient-years, respectively, whereas incidence of advanced neoplasia were 0.6%[95%CI:0.2%-1.00%] and 1.0%[95%CI:0.6%-1.5%] patient-years, respectively. Pooled incidence of disease-specific mortality during initial and extended surveillance were 0.3% [95%CI:0.1% - 0.6%] and 0.6% [95%CI: 0.0%-1.6%] patient-years, respectively. Among BD-IPMNs with initial size stability, extended surveillance had WF/HRS and advanced neoplasia incidence of 1.9%[95%CI:1.2%-2.8%] and 0.2%[95%CI:0.1%-0.5%] patient-years, respectively. A lower incidence of advanced neoplasia during extended surveillance among low-risk, stable-sized BD-IPMNs is a key finding of this study.

Source: https://www.sciencedirect.com/science/article/abs/pii/S1542356522004505?via=ihub