title: Active Surveillance Beyond 5 Years Is Required for Presumed Branch-Duct Intraductal Papillary Mucinous Neoplasms Undergoing Non-Operative Management.
abstract: OBJECTIVE
  To evaluate the results of active surveillance beyond 5 years in patients with branch-duct intraductal papillary mucinous neoplasms (BD-IPMNs) without worrisome features (WF) and high-risk stigmata (HRS) undergoing non-operative management.
  
  
  METHODS
  Patients with a minimum follow-up of 5 years who underwent surveillance with at least yearly magnetic resonance imaging were included. New onset of and predictors of WF/HRS during follow-up as well as long-term survival were analyzed.
  
  
  RESULTS
  In all, 144 patients were followed for a median of 84 months. At diagnosis multifocal BD-IPMNs were found in 53% of cases and mean size of the largest cyst was 15.5 mm. Changes during follow-up were observed in 69 patients (48%). New onset of WF/HRS were observed in 26 patients (18%) but the rate of HRS was only 4%. WF and HRS developed after a median follow-up of 71 and 77.5 months from diagnosis, respectively, and without previous changes in 19/26 patients. Independent predictors of WF/HRS development were size at diagnosis>15 mm, increase in number of lesions, main pancreatic duct growth rate ≥0.2 mm/year, cyst growth rate >1 mm/year. Overall, the rate of pancreatic invasive malignancy was 2% and the 12-year disease-specific survival was 98.6%.
  
  
  CONCLUSIONS
  Long-term nonoperative management is safe for BD-IPMNs without WF and HRS. Discontinuation of surveillance cannot be recommended since one out of six patients developed WF/HRS far beyond 5 years of surveillance and without previous relevant modifications. An intensification of follow-up should be considered after 5 years.
authors.affiliation: Department of Surgery, Sacro Cuore-Don Calabria Hospital, Negrar, Verona, Italy.|Pancreas Translational &Clinical Research Center, Division of Pancreatic Surgery, Università Vita-Salute, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Crippa
authors.affiliation: Pancreas Unit, Department of Digestive System, Sant'Orsola-Malpighi Hospital, Bologna, Italy.
authors.forename: Raffaele
authors.initials: R
authors.lastname: Pezzilli
authors.affiliation: Division of Transplant Surgery, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Bissolati
authors.affiliation: Digestive and Liver Disease Unit, S. Andrea Hospital, University Sapienza, Rome, Italy.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Capurso
authors.affiliation: Department of Radiology, Sacro Cuore-Don Calabria Hospital, Negrar, Verona, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Romano
authors.affiliation: Division of Gastroenterology, Sacro Cuore-Don Calabria Hospital, Negrar, Verona, Italy.
authors.forename: Maria Paola
authors.initials: MP
authors.lastname: Brunori
authors.affiliation: Department of Radiology, Sant'Orsola-Malpighi Hospital, Bologna, Italy.
authors.forename: Lucia
authors.initials: L
authors.lastname: Calculli
authors.affiliation: Department of Surgery, Sacro Cuore-Don Calabria Hospital, Negrar, Verona, Italy.|Pancreas Translational &Clinical Research Center, Division of Pancreatic Surgery, Università Vita-Salute, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Domenico
authors.initials: D
authors.lastname: Tamburrino
authors.affiliation: Pancreas Translational &Clinical Research Center, Division of Pancreatic Surgery, Università Vita-Salute, San Raffaele Scientific Institute, Milan, Italy.|Department of Surgery, Università Politecnica delle Marche, Ancona, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Piccioli
authors.affiliation: Department of Surgery, Sacro Cuore-Don Calabria Hospital, Negrar, Verona, Italy.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Ruffo
authors.affiliation: Digestive and Liver Disease Unit, S. Andrea Hospital, University Sapienza, Rome, Italy.
authors.forename: Gianfranco Delle
authors.initials: GD
authors.lastname: Fave
authors.affiliation: Department of Surgery, Sacro Cuore-Don Calabria Hospital, Negrar, Verona, Italy.|Pancreas Translational &Clinical Research Center, Division of Pancreatic Surgery, Università Vita-Salute, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Falconi
mesh_terms: D002288:Adenocarcinoma, Mucinous / Q000473:pathology* / Q000628:therapy*; D000231:Adenocarcinoma, Papillary / Q000473:pathology* / Q000628:therapy*; D044963:Biopsy, Fine-Needle; D021441:Carcinoma, Pancreatic Ductal / Q000473:pathology* / Q000628:therapy*; D049448:Cholangiopancreatography, Magnetic Resonance; D018450:Disease Progression; D019160:Endosonography; D005260:Female; D006801:Humans; D007558:Italy; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010183:Pancreatic Ducts / Q000473:pathology*; D010190:Pancreatic Neoplasms / Q000473:pathology* / Q000628:therapy*; D011159:Population Surveillance; D011379:Prognosis; D013997:Time Factors