Year 2026 / Volume 118 / Number 1
Original
Is surveillance warranted for presumed branch-duct intraductal papillary mucinous neoplasms diagnosed at age 75 or older? A single-center retrospective cohort study

20-27

DOI: 10.17235/reed.2025.11376/2025

José Lariño Noia, Yessica Domínguez Novoa, Mónica Otero Iglesias, Martiño Loureiro Veira, Marco Galego Fernández, Alberto Rama Fernández, Daniel de la Iglesia, Julio Iglesias García, Enrique Domínguez Muñoz,

Abstract
Introduction: incidental cystic pancreatic lesions are increasingly detected in the aging population, with branch-duct intraductal papillary mucinous neoplasms (BD-IPMNs) being the most common. This study aimed to evaluate the benefits of implementing a surveillance program in patients diagnosed with presumed BD-IPMN at the age of 75 years or older. Methods: a retrospective analysis was conducted using a prospective registry of patients diagnosed incidentally with presumed BD-IPMN at ≥ 75 years of age. Patients were categorized into two groups: group A, who underwent clinical and imaging follow-up, and group B, with no surveillance. Clinical records were reviewed to assess pancreatic cancer incidence, overall survival, and mortality. Results: among 434 patients with BD-IPMN, 93 met inclusion criteria (42 in group A; 51 in group B). The mean age was 77 years in group A and 79.2 years in group B (p = 0.016). The mean cyst size was 15.6 mm in group A and 14.6 mm in group B (p = 0.56). No cases of pancreatic cancer were identified in group A, while one case occurred in group B (p = 1.0). Five patients died in each group (p = 1.0). Overall survival was comparable between groups (HR 0.8; 95 % CI: 0.22-2.94; p = 0.74). Conclusions: presumed incidental BD-IPMNs diagnosed at ≥ 75 years of age rarely progress to pancreatic cancer. In patients with cysts < 2 cm and without high-risk features, surveillance does not appear to confer a survival benefit and may therefore be unnecessary.
Lay Summary
Follow-up of incidental cystic pancreatic lesions represents a significant burden for healthcare systems. Given the risk of developing pancreatic cancer, it is crucial to prioritize which patients may truly benefit from inclusion in a surveillance program. In this study, we evaluated whether individuals aged 75 years or older, diagnosed with an incidental pancreatic cyst, benefit from follow-up. We compared two groups: one received surveillance according to international guidelines, while the other did not undergo any specific clinical or imaging follow-up. Our results show that patients diagnosed with incidental pancreatic cysts at age 75 or older have the same probability of developing pancreatic cancer or dying, regardless of whether they were included in a follow-up program. Therefore, surveillance is not recommended for these patients. These conclusions apply to incidental pancreatic cysts smaller than 2 cm in diameter and without high-risk features at diagnosis. Our findings help define clear criteria for including patients in follow-up programs, with the important benefit of reducing the economic and healthcare burden on health systems.
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Lariño Noia J, Domínguez Novoa Y, Otero Iglesias M, Loureiro Veira M, Galego Fernández M, Rama Fernández A, et all. Is surveillance warranted for presumed branch-duct intraductal papillary mucinous neoplasms diagnosed at age 75 or older? A single-center retrospective cohort study. 11376/2025


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Publication history

Received: 29/05/2025

Accepted: 30/07/2025

Online First: 29/09/2025

Published: 14/01/2026

Article revision time: 47 days

Article Online First time: 123 days

Article editing time: 230 days


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