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Should Patients with Cystic Lesions of the Pancreas Undergo Long-Term Radiographic Surveillance? Results of 3,024 Patients Evaluated at a Single Institution
Sharon A Lawrence, Marc A Attiyeh, Kenneth Seier, Mithat Gonen, Vinod Balachandran, T Peter Kingham, Michael I D'Angelica, Ronald DeMatteo, Murray F Brennan, William R Jarnagin, Peter J Allen
Memorial Sloan Kettering Cancer Center, New York, NY

Objective: In 2015, the American Gastroenterological Association recommended discontinuing radiographic surveillance after five years in patients with stable cysts. This study evaluated the yield of continued surveillance of pancreatic cysts after five years of follow-up.
Methods: A prospectively maintained registry of patients evaluated for pancreatic cysts was queried (1995-2016). Patients initially followed were divided into those with <5yrs and ≥5yrs of follow-up. Analyses for the presence of cyst growth (>5mm increase in diameter), cross-over to resection, and development of carcinoma were performed.
Results: A total of 3,024 patients were identified, with 2,472 undergoing initial surveillance. The ≥5yrs group (n=596) experienced a greater frequency of cyst growth (44%vs20%;p<0.0001), a lower rate of cross-over to resection (8%vs11%;p=0.02), and a similar frequency of progression to carcinoma (2%vs3%;p=0.07) compared to the <5yrs group (n=1876). Within the ≥5yrs group, 414 patients (69%) demonstrated radiographic stability at the five-year time point. This subgroup, when compared to the <5yr group, experienced similar rates of cyst growth (19%vs20%;p=0.89) and lower rates of cross-over to resection (5%vs11%;p<0.0001) and development of carcinoma (1%vs3%;p=0.0084). The observed-to-expected ratio for developing carcinoma in those radiographically stable at 5yrs was 31.3 per 100,000 per year, compared to 12.4 per 100,000 per year in the general population as per SEER.
Conclusion: Cyst size stability at the five-year time point did not preclude future growth, cross-over to resection, or carcinoma development. Patients who were stable at five years had a 3-fold higher risk of developing cancer compared to the general population and should continue long-term surveillance.

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