Systematic Review on Different Values of Surveillance by Age in Branch Duct Intraductal Papillary Mucinous Neoplasms of the Pancreas.

Abstract

Background and aims: Surveillance strategies for presumed low-risk branch-duct intraductal papillary mucinous neoplasms (BD-IPMNs) remain controversial, especially in the absence of malignancy predictors. This systematic review and meta-analysis aimed to evaluate the impact of age on surveillance decisions for BD-IPMNs without high-risk features at baseline.

Methods: Following PRISMA guidelines, a systematic search (January 2006-August 2024) using the terms "epidemiology" and "pancreatic intraductal neoplasm" was conducted. Sixty-six studies reporting the natural history of BD-IPMNs without worrisome features (WF) or high-risk stigmata (HRS) at diagnosis were included. Age-related trends in IPMN progression and pooled incidence rates were analyzed by meta-analyses.

Results: The pooled incidence of WF was 2.0% per patient-year and HRS was 0.46%. Advanced pancreatic neoplasia developed at 0.49% per patient-year overall, decreasing to 0.26% during extended surveillance beyond 5 years in stable cases. Concomitant pancreatic ductal adenocarcinoma occurred at 0.23% per patient-year, with a median diagnosis time of 3.1 years. Age alone was not a significant predictor of progression, though some studies proposed age thresholds when combined with other clinical factors.

Conclusions: Discontinuing surveillance may be reasonable in patients aged ≥ 75 years with BD-IPMN < 20 mm, no WF/HRS, ≥ 5 years of stability, and Charlson Comorbidity Index > 3.