What is the Risk of Pancreatic Cancer in Patients with Low-Risk IPMNs?
Low-risk intraductal papillary mucinous neoplasms have an almost 8% chance of progressing to pancreatic cancer within 10 years, whereas higher-risk IPMNs have almost 25% chance, reports a systematic review and meta-analysis in the October issue of Clinical Gastroenterology and Hepatology. Continued long-term surveillance is therefore important for patients with low-risk, as well as higher-risk, IPMNs.
IPMNs have been detected more frequently with the widespread use of cross-sectional abdominal imaging. Little is known about their prevalence, because many IPMNs are asymptomatic, but series studies have reported prevalence values ranging from 2.6% to 13.5%.
Although there is general agreement that IPMNs with enhanced solid components or main pancreatic duct diameter ≥10 mm should be surgically resected, guidelines are not clear about management of smaller IPMNs. American Gastroenterological Association guidelines propose stopping surveillance for pancreatic cysts smaller than 3 cm without a solid component or a dilated pancreatic duct if there has been no significant change for 5 years, based on low-quality evidence. However, the best management strategies for low-risk IPMN lesions (observation vs surgery), and the time of observation, are unclear.