title: Long-term follow-up of neoplastic pancreatic cysts without high-risk stigmata: how often do we change treatment strategy because of malignant transformation?
abstract: *
  
  
  OBJECTIVE
  Patients with potentially premalignant neoplastic pancreatic cysts without high-risk stigmata usually enter a surveillance program. Data on outcomes of such surveillance programs are scarce. We aimed to evaluate the resection rate and malignancy rate during follow-up.
  
  
  METHODS
  From our prospective database (2006-2015) of patients with pancreatic cysts, we analyzed patients with pancreatic cysts without high-risk stigmata with at least six months follow-up.
  
  
  RESULTS
  In total, 146 patients were followed for a median of 29 months (IQR 13.5-50 months). In 124 patients (84.9%), no changes in clinical or imaging characteristics occurred during follow-up. Thirteen patients (8.9%) developed an indication for surgery after a median follow-up of 25 months (IQR 12-42 months). Two patients did not undergo surgery because of comorbidity, 11 patients (7.5%) underwent resection. Indications for surgery were symptoms (n = 2), development of a pancreatic mass (n = 1), a new nodule (n = 2), thickened cyst wall (n = 1), pancreatic duct dilation (n = 3), and/or suspicion of mucinous cystic neoplasm (MCN) (n = 3). Postoperative histology showed one pancreatic malignancy not originating from the cyst, three mixed type-intraductal papillary mucinous neoplasm (IPMN), one side branch-IPMN, two MCN, one neuroendocrine tumor, one serous cystadenoma, one inflammatory cyst, and one lymphangioma. The highest grade of cyst dysplasia was borderline dysplasia.
  
  
  CONCLUSIONS
  Most neoplastic pancreatic cysts without high-risk stigmata at initial presentation show no substantial change during 1-4-year follow-up. Only 7.5% of patients underwent surgery and less than 1% of patients developed pancreatic malignancy. This indicates that additional markers are needed to tailor treatment of pancreatic cysts.
authors.affiliation: a Department of Gastroenterology and Hepatology , Academic Medical Center, University of Amsterdam , Amsterdam , The Netherlands ;
authors.forename: Selma J
authors.initials: SJ
authors.lastname: Lekkerkerker
authors.affiliation: b Department of Surgery , Academic Medical Center , Amsterdam , The Netherlands ;
authors.forename: Marc G
authors.initials: MG
authors.lastname: Besselink
authors.affiliation: b Department of Surgery , Academic Medical Center , Amsterdam , The Netherlands ;
authors.forename: Olivier R
authors.initials: OR
authors.lastname: Busch
authors.affiliation: c Department of Pathology , Academic Medical Center , Amsterdam , The Netherlands ;
authors.forename: Frederike
authors.initials: F
authors.lastname: Dijk
authors.affiliation: d Department of Radiology , Academic Medical Center , Amsterdam , The Netherlands.
authors.forename: Marc R
authors.initials: MR
authors.lastname: Engelbrecht
authors.affiliation: a Department of Gastroenterology and Hepatology , Academic Medical Center, University of Amsterdam , Amsterdam , The Netherlands ;
authors.forename: Erik A
authors.initials: EA
authors.lastname: Rauws
authors.affiliation: a Department of Gastroenterology and Hepatology , Academic Medical Center, University of Amsterdam , Amsterdam , The Netherlands ;
authors.forename: Paul
authors.initials: P
authors.lastname: Fockens
authors.affiliation: a Department of Gastroenterology and Hepatology , Academic Medical Center, University of Amsterdam , Amsterdam , The Netherlands ;
authors.forename: Jeanin E
authors.initials: JE
authors.lastname: van Hooft
mesh_terms: D000328:Adult; D000368:Aged; D002471:Cell Transformation, Neoplastic; D049448:Cholangiopancreatography, Magnetic Resonance; D016208:Databases, Factual; D018450:Disease Progression; D019160:Endosonography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009426:Netherlands; D010181:Pancreatic Cyst / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000601:surgery; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000601:surgery; D017410:Practice Guidelines as Topic; D011230:Precancerous Conditions / Q000473:pathology*; D012189:Retrospective Studies; D062606:Tertiary Care Centers; D016896:Treatment Outcome
keywords: Disease progression; neoplasm staging; pancreatic neoplasms; precancerous conditions