Original Contribution | Published:

Pancreas and Biliary Tract

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

The American Journal of Gastroenterology volume 112, pages 11531161 (2017) | Download Citation

Abstract

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.

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Author information

Affiliations

  1. Department of Surgery, Sacro Cuore-Don Calabria Hospital, Negrar, Verona, Italy

    • Stefano Crippa
    • , Domenico Tamburrino
    • , Giacomo Ruffo
    •  & Massimo Falconi
  2. Pancreas Translational & Clinical Research Center, Division of Pancreatic Surgery, Università Vita-Salute, San Raffaele Scientific Institute, Milan, Italy

    • Stefano Crippa
    • , Domenico Tamburrino
    • , Alessandra Piccioli
    •  & Massimo Falconi
  3. Pancreas Unit, Department of Digestive System, Sant'Orsola-Malpighi Hospital, Bologna, Italy

    • Raffaele Pezzilli
  4. Division of Transplant Surgery, San Raffaele Scientific Institute, Milan, Italy

    • Massimiliano Bissolati
  5. Digestive and Liver Disease Unit, S. Andrea Hospital, University Sapienza, Rome, Italy

    • Gabriele Capurso
    •  & Gianfranco Delle Fave
  6. Department of Radiology, Sacro Cuore-Don Calabria Hospital, Negrar, Verona, Italy

    • Luigi Romano
  7. Division of Gastroenterology, Sacro Cuore-Don Calabria Hospital, Negrar, Verona, Italy

    • Maria Paola Brunori
  8. Department of Radiology, Sant'Orsola-Malpighi Hospital, Bologna, Italy

    • Lucia Calculli
  9. Department of Surgery, Università Politecnica delle Marche, Ancona, Italy

    • Alessandra Piccioli

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Competing interests

Guarantor of the article: Stefano Crippa, MD, PhD.

Specific author contributions: Planning and conducting the study, collecting and interpreting the data, and drafting the manuscript: Stefano Crippa; collecting and interpreting data, drafting the manuscript and critical review of the manuscript: Raffaele Pezzilli, Gabriele Capurso, Giacomo Ruffo; collecting and interpreting data, and critical review of the manuscript: Luigi Romano, Maria Paola Brunori, Lucia Calculli, Domenico Tamburrino, Alessandra Piccioli; performing the statistical analysis, interpreting data and critical review of the manuscript: Massimiliano Bissolati; performed the statistical analysis and assisted in the interpretation of the results and in the critical review of the paper; planning the study, interpreting the data, drafting the manuscript and critical review of the paper: Massimo Falconi, Gianfranco Delle Fave.

Financial support: None.

Potential competing interests: None.

Corresponding author

Correspondence to Stefano Crippa.

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DOI

https://doi.org/10.1038/ajg.2017.43

SUPPLEMENTARY MATERIAL is linked to the online version of the paper at http://www.nature.com/ajg

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