OBJECTIVE To review the surveillance of IPMN, the risk of pancreatic cancer and the cost of surveillance. BACKGROUND The increasing IPMN prevalence and low pancreatic cancer associated with IPMN question the necessity and cost-effectiveness of surveillance. Guidelines favour a 'watch and wait' approach, lacking clarity on stopping surveillance. This study aims to identify patients with pancreatic cancer risk equivalent to their age group, create guidelines for stopping surveillance and reduce NHS costs. METHODS Retrospective analysis of IPMN patients on surveillance in the WoS. Clinicopathological data were collected. Endpoints included pancreatic cancer development and surveillance pathway cost estimation. Age-matched controls were used for comparison using standardised incidence ratios (SIRs) for pancreatic cancer. RESULTS Of 746 patients, 27 (3.62%) were resected. 3 (0.402%) developed pancreatic cancer and 44 (5.90%) developed worrisome features/ high-risk stigmata after a median surveillance of 48 (IQR 48) months. 221 (29.6%) had a stable cyst for at least 5 years and their SIR was 1.56 (95% CI 0.04-8.71). Patients ≥75 years with stable cysts for ≥5 years, SIR was 1.71 (95% CI 0.03-3.42). Patients ≥65 years with stable cysts of <15 mm for ≥5 years and patients with stable cysts of <10 mm for ≥5 years, had SIRs of 0. The cost of surveillance was £6,330.36 ($8,105.65) per resected patient and £2,032.78 ($2,602.85) per non-resected patient. CONCLUSION Patients with stable IPMNs have similar pancreatic cancer risk as the general population. Surveillance discontinuation can be considered after 5 years in a cohort of patients, saving £106,211.19 ($136,020.42) per year.

中文翻译：

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导管内胰腺粘液性肿瘤的监测策略：停药标准。


目的 回顾 IPMN 的监测、胰腺癌的风险和监测成本。背景 IPMN 患病率的增加和与 IPMN 相关的低胰腺癌发病率质疑监测的必要性和成本效益。指南倾向于“观察和等待”的方法，对停止监测缺乏明确规定。本研究旨在确定胰腺癌风险与其年龄组相当的患者，制定停止监测的指南并降低 NHS 成本。方法 回顾性分析在 WoS 中接受监测的 IPMN 患者。收集临床病理资料。终点包括胰腺癌发展和监测途径成本估计。使用胰腺癌的标准化发病率比 （SIR） 比较年龄匹配的对照。结果 746 例患者中，27 例 （3.62%） 被切除。3 例 （0.402%） 患上胰腺癌，44 例 （5.90%） 在中位监测 48 （IQR 48） 个月后出现令人担忧的特征/高危红斑。221 例 （29.6%） 的囊肿稳定至少 5 年，SIR 为 1.56 （95% CI 0.04-8.71）。≥75 岁且囊肿稳定 ≥5 年的患者，SIR 为 1.71 （95% CI 0.03-3.42）。65 岁且 <15 mm 稳定囊肿持续 ≥5 年≥的患者和 <10 mm 稳定囊肿 ≥5 年的患者，SIR 为 0。监测费用为每名切除患者 6,330.36 英镑（8,105.65 美元），每名未切除患者 2,032.78 英镑（2,602.85 美元）。结论 IPMN 稳定的患者患胰腺癌的风险与一般人群相似。对于一组患者，可以考虑在 5 年后停止监测，每年可节省 106,211.19 英镑（136,020.42 美元）。