Natural History of Pancreatic Cyst with Diameter as Solitary Risk Factor

Abstract

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

Study design: 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.

Results: 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.

Conclusions: 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.