Active Surveillance Beyond 5 Years Is Required for Presumed Branch-Duct Intraductal Papillary Mucinous Neoplasms Undergoing Non-Operative Management

Am J Gastroenterol. 2017 Jul;112(7):1153-1161. doi: 10.1038/ajg.2017.43. Epub 2017 Feb 28.


Objectives: To evaluate the results of active surveillance beyond 5 years in patients with branch-duct intraductal papillary mucinous neoplasms (BD-IPMNs) without worrisome features (WF) and high-risk stigmata (HRS) undergoing non-operative management.

Methods: Patients with a minimum follow-up of 5 years who underwent surveillance with at least yearly magnetic resonance imaging were included. New onset of and predictors of WF/HRS during follow-up as well as long-term survival were analyzed.

Results: In all, 144 patients were followed for a median of 84 months. At diagnosis multifocal BD-IPMNs were found in 53% of cases and mean size of the largest cyst was 15.5 mm. Changes during follow-up were observed in 69 patients (48%). New onset of WF/HRS were observed in 26 patients (18%) but the rate of HRS was only 4%. WF and HRS developed after a median follow-up of 71 and 77.5 months from diagnosis, respectively, and without previous changes in 19/26 patients. Independent predictors of WF/HRS development were size at diagnosis>15 mm, increase in number of lesions, main pancreatic duct growth rate ≥0.2 mm/year, cyst growth rate >1 mm/year. Overall, the rate of pancreatic invasive malignancy was 2% and the 12-year disease-specific survival was 98.6%.

Conclusions: Long-term nonoperative management is safe for BD-IPMNs without WF and HRS. Discontinuation of surveillance cannot be recommended since one out of six patients developed WF/HRS far beyond 5 years of surveillance and without previous relevant modifications. An intensification of follow-up should be considered after 5 years.

Publication types

  • Multicenter Study

MeSH terms

  • Adenocarcinoma, Mucinous / pathology*
  • Adenocarcinoma, Mucinous / therapy*
  • Adenocarcinoma, Papillary / pathology*
  • Adenocarcinoma, Papillary / therapy*
  • Biopsy, Fine-Needle
  • Carcinoma, Pancreatic Ductal / pathology*
  • Carcinoma, Pancreatic Ductal / therapy*
  • Cholangiopancreatography, Magnetic Resonance
  • Disease Progression
  • Endosonography
  • Female
  • Humans
  • Italy
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Pancreatic Ducts / pathology*
  • Pancreatic Neoplasms / pathology*
  • Pancreatic Neoplasms / therapy*
  • Population Surveillance*
  • Prognosis
  • Time Factors