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Background: Pancreatic cysts are increasingly diagnosed among patients undergoing abdominal imaging. Irrespective of conservative vs. surgical management, patients with mucinous neoplasms should be followed given concern for progression to malignancy or recurrence following surgery. The optimal frequency of follow-up imaging and the prevalence of recurrence after resection are not known.
Methods: 163 patients with branch-duct intraductal papillary mucinous neoplasms (BD-IPMNs) and mucinous cystic neoplasms (MCNs) were identified and divided in patients treated surgically or observed. Demographics, relevant co-morbidities, cyst characteristics, frequency and interval between imaging as well as time to recurrence were registered. Kaplan-Meier curves and regression models were used to estimate the distribution of time to recurrence and factors associated with recurrence.
Results: 92 patients were followed conservatively while 71 underwent surgery (Table-1). None of the surveilled patients experienced significant increase in lesion size (median follow-up: 36 months). For patients undergoing resection the probability of recurrence was 4% at 2 years, and significantly higher in those with non-invasive BD-IPMNs vs. MCNs (9% vs.0% respectively, p<0.05). Follow-up rates were significantly lower in patients undergoing surgery vs. surveillance (77% vs. 95%, respectively, p<0.01).
Conclusions: Non-resected asymptomatic BD-IPMNs and MCNs do not require imaging follow-up before year-3 from diagnosis to ensure an efficient use of medical resources. Resected non-invasive mucinous neoplasms necessitate imaging surveillance by year-2 after surgery to detect early recurrence. For patients undergoing resection we recommend reinforcement to enhance follow-up.