The Surveillance Strategy for Intraductal Pancreatic Mucinous Neoplasms: Criteria for Discontinuation

Abstract

Objective: – To review the surveillance of intraductal papillary mucinous neoplasm (IPMN), the risk of pancreatic cancer, and the cost of surveillance. Background: – The increasing IPMN prevalence and low pancreatic cancer associated with IPMN question the necessity and cost-effectiveness of surveillance. Guidelines favor a “watch and wait” approach, lacking clarity on stopping surveillance. This study aims to identify patients with pancreatic cancer risk equivalent to their age group, create guidelines for stopping surveillance, and reduce National Health Service costs. Methods: – Retrospective analysis of patients with IPMN on surveillance in the West of Scotland. Clinicopathological data were collected. Endpoints included pancreatic cancer development and surveillance pathway cost estimation. Age-matched controls were used for comparison using standardized incidence ratios (SIRs) for pancreatic cancer. Results: – Of 746 patients, 27 (3.62%) were resected. Three (0.402%) developed pancreatic cancer and 44 (5.90%) developed worrisome features/high-risk stigmata after a median surveillance of 48 (interquartile range: 48) months. Two hundred twenty-one (29.6%) had a stable cyst for at least 5 years and their SIR was 1.56 (95% CI: 0.04–8.71). For patients ≥75 years with stable cysts for ≥5 years, SIR was 1.71 (95% CI: 0.03–3.42). Patients ≥65 years with stable cysts of <15 mm for ≥5 years and patients with stable cysts of <10 mm for ≥5 years had SIRs of 0. The cost of surveillance was £6, 330.36 ($8, 105.65) per resected patient and £2, 032.78 ($2, 602.85) per nonresected patient. Conclusions: – Patients with stable IPMNs have similar pancreatic cancer risk as the general population. Surveillance discontinuation can be considered after 5 years in a cohort of patients, saving £106, 211.19 ($136, 020.42) per year.