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

Abstract

Multiple pancreatic cyst surveillance guidelines include cyst diameter 3 cm or greater as a worrisome feature prompting surgical referral. This was a single-center retrospective review of patients with pancreatic cysts 3 cm or greater 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-intraductal papillary mucinous neoplasm cysts at initial consultation were excluded. Between 2010 and 2019, 89 patients met eligibility criteria with median age of 70.9 (21 to 91) years, cyst size of 3.5 (3.10 to 9.7) cm, and follow-up of 85.7 (30.8 to 139.3) months. Cyst progression or resection occurred in 13 during follow-up There were no cases of pancreatic cancer or high-grade dysplasia on postoperative pathology. Twelve patients (13%) died without evidence of progression. Cumulative incidence of progression from surveillance initiation was 3.4% (95% CI 0.9% to 8.8%) at 3 months, 5.6% (95% CI 2.1% to 11.9%) at 9 months, 9.0% (95% CI 4.2% to 16.2%) at 15 months, 11.2% (95% CI 5.7% to 18.8%) at 21 months, and 13.7% (95% CI 7.5% to 21.8%) at 57 months. Pancreatic cysts with a diameter 3 cm or greater 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.