Outcomes in Intra-ductal Papillary Mucinous Neoplasms in the New York Harbor Veteran Population

Abstract

Introduction: Intra-ductal papillary mucinous neoplasms (IPMN) have become more frequently and incidentally diagnosed in recent years due to increases in imaging procedures. With recommendations based on weak evidence, the only consistent recommendation is for surgical intervention in patients with main duct lesions, branch duct lesions greater than 3 cm, or a solid component of the cyst. The intent of our study is to evaluate the natural history of incidental pancreatic cysts and to determine if these lesions have an effect on morbidity and mortality. Methods: Retrospective chart review was performed on patients with diagnosis of pancreatic cyst, pancreatic lesion, and intra-ductal pancreatic mucinous neoplasm from the New York Harbor Veterans Affairs Hospital from 2000 to 2015. Of 767 patients, 116 were randomly selected for further analysis. Charts were reviewed for outcomes which included progression of IPMN into disease or death of patient from pancreatic or other causes. Results: Of the 116 patients with pancreatic cysts, 47 patients were diagnosed with IPMN. Baseline characteristics are outlined in Table 1. In summary, all patients were male, more than half of patients were over age 70 at diagnosis and more than half had BMI greater than 25. There were few Hispanic (7%) or Asian (0%) patients, with most patients self-identifying as white (42.6%) or black (40.4%). In terms of patient outcomes (Table 2), only 8 of 47 patients had passed away at time of publication, with 3 passing from a pancreatic etiology, 2 being pancreatic cancer. Only 17 (36.2%) patients underwent EUS to further evaluate the cysts and 4 of these 17 had FNA sampling of the cyst. Out of 47 patients, 4 underwent surgical removal of pancreatic lesions and all 4 pathology samples showed IPMN without malignancy.Table: Table. Baseline CharacteristicsTable: Table. IPMN characteristics and outcomesConclusion: Currently, management of IPMNs is based on consensus rather than strong evidence. This study preliminarily supports the evolution of management to conservatively observing these lesions. However, as with many published studies on IPMNs, this study has limitations such as advanced age, all male sample and multiple comorbidities preventing further invasive interventions. Because of this, our findings cannot be applied to the general population. Therefore we recommend further larger multicenter trials to establish the risk of IMPN's developing into pancreatic cancer, specifically in the aging population.