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Should Patients With Cystic Lesions of the Pancreas Undergo Long-term Radiographic Surveillance?: Results of 3024 Patients Evaluated at a Single Institution

Lawrence, Sharon A. MD*; Attiyeh, Marc A. MD*; Seier, Kenneth MS; Gönen, Mithat PhD; Schattner, Mark MD; Haviland, Dana L. BM*; Balachandran, Vinod P. MD*; Kingham, T. Peter MD*; D’Angelica, Michael I. MD*; DeMatteo, Ronald P. MD*; Brennan, Murray F. MD*; Jarnagin, William R. MD*; Allen, Peter J. MD*

doi: 10.1097/SLA.0000000000002371

Objective: In 2015, the American Gastroenterological Association recommended the discontinuation of radiographic surveillance after 5 years for patients with stable pancreatic cysts. The current study evaluated the yield of continued surveillance of pancreatic cysts up to and after 5 years of follow up.

Methods: A prospectively maintained registry of patients evaluated for pancreatic cysts was queried (1995–2016). Patients who initially underwent radiographic surveillance were divided into those with <5 years and ≥5 years of follow up. Analyses for the presence of cyst growth (>5 mm increase in diameter), cross-over to resection, and development of carcinoma were performed.

Results: A total of 3024 patients were identified, with 2472 (82%) undergoing initial surveillance. The ≥5 year group (n = 596) experienced a greater frequency of cyst growth (44% vs. 20%; P < 0.0001), a lower rate of cross-over to resection (8% vs 11%; P = 0.02), and a similar frequency of progression to carcinoma (2% vs 3%; P = 0.07) compared with the <5 year group (n = 1876). Within the ≥5 year group, 412 patients (69%) had demonstrated radiographic stability at the 5-year time point. This subgroup, when compared with the <5 year group, experienced similar rates of cyst growth (19% vs. 20%; P= 0.95) and lower rates of cross-over to resection (5% vs 11%; P< 0.0001) and development of carcinoma (1% vs 3%; P= 0.008). The observed rate of developing cancer in the group that was stable at the 5-year time point was 31.3 per 100,000 per year, whereas the expected national age-adjusted incidence rate for this same group was 7.04 per 100,000 per year.

Conclusion: Cyst size stability at the 5-year time point did not preclude future growth, cross-over to resection, or carcinoma development. Patients who were stable at 5 years had a nearly 3-fold higher risk of developing cancer compared with the general population and should continue long-term surveillance.

*Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY

Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY

Division of Gastroenterology, Memorial Sloan Kettering Cancer Center, New York, NY.

Reprints: Peter J. Allen, MD, Department of Surgery, C896, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021. E-mail:

Disclosure: This study was supported in part by NIH/NCI Cancer Center Support Grant (P30 CA008748).

The authors declare no conflicts of interest.

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