Natural History of Pancreatic Cyst with Diameter as the Solitary Risk Factor.

Abstract

Background: Multiple pancreatic cyst surveillance guidelines include cyst diameter ≥3cm as a worrisome feature prompting surgical referral.

Methods: Single center retrospective review of patients with pancreatic cysts ≥3cm at diagnosis and no other worrisome features. Cyst progression was defined as the development of additional worrisome features, pancreatic cancer diagnosis, or pancreatectomy. Pseudocysts and biopsy proven malignancies or non-IPMN cysts at initial consultation were excluded.

Results: Between 2010-2019, 89 patients met eligibility criteria with median age 70.9 (21-91), cyst size 3.5cm (3.10-9.7cm), and follow-up of 85.7 months (30.8-139.3). Cyst progression or resection occurred in 13 during follow-up There were no cases of pancreatic cancer or high-grade dysplasia on post-operative pathology. 12 patients (13%) died without evidence of progression. Cumulative incidence of progression from surveillance initiation was 3.4% [95%CI: 0.9%-8.8%] at 3 months, 5.6% [95%CI: 2.1%-11.9%] at 9 months, 9.0% [95%CI: 4.2%-16.2%] at 15 months, 11.2% [95%CI: 5.7%-18.8%] at 21 months, and 13.7% [95%CI: 7.5%-21.8%] at 57 months.

Conclusion: Pancreatic cysts with diameter ≥3cm as the sole worrisome feature can be safely monitored with low rates of progression during surveillance, and no incidence of cancer or high-grade dysplasia in our cohort.