Researchers at Yale Cancer Center, affiliated with Yale School of Medicine, have conducted a study questioning the necessity of extended surveillance for low-risk branch duct intraductal papillary mucinous neoplasms (IPMN) of the pancreas. IPMN is a common precancerous form of mucinous pancreatic cysts that requires regular imaging surveillance. The study, published in Clinical Gastroenterology and Hepatology in June 2023, aimed to determine the health benefits of extended surveillance for patients whose cysts did not change in size for at least five years and had no worrisome features.
Dr. James Farrell, the senior author of the study and director of the Yale Center for Pancreatic Diseases, highlighted the controversy surrounding the guidelines for surveillance cessation. The study emphasized the persistent risk of malignancy even after five or ten years of surveillance.
The researchers conducted a systematic review of 41 IPMN surveillance studies. They compared the incidence of worrisome features and high-risk stigmata (WF/HRS) as well as advanced neoplasia, including pancreatic cancer, during the initial surveillance period (within the first five years) and the extended surveillance period (after five years).
The findings revealed that the risk of WF/HRS increased from 2.2% during the initial surveillance to 2.9% patient-years during extended surveillance. Similarly, the risk of advanced neoplasia rose from 0.6% to 1.0% patient-years between the initial and extended periods. However, among patients whose cyst size remained stable for five years or more, extended surveillance showed a lower risk of WF/HRS (1.9% patient-years) and advanced neoplasia (0.2% patient-years).
The study suggests that for patients with stable cyst size for five years or more, extended surveillance may not provide a significant survival benefit. However, the researchers emphasized the need for more high-quality studies before surveillance cessation can be recommended.
Dr. Farrell stated that a deeper understanding of the biology and natural progression of pancreatic cysts is necessary to improve surveillance strategies. This knowledge would enable more informed decisions regarding which patients require closer follow-up and which patients could undergo decreased surveillance.
Source: Yale Cancer Center/Smilow Cancer Hospital