The majority of studies on Intraductal Papillary Mucinous Neoplasms (IPMNs) are retrospective with inherited selection bias. We report long-term, real-life data from prospective PANcreatic CYsts (PANCY) registry to analyze outcomes of patients with IPMNs, focusing on low-risk branch duct (BD) IPMN.

patients with pancreatic cystic neoplasms were enrolled in a prospective observational multicentric registry between 2015 and 2017 ; surveillance was proposed to enrolled patients until December 31st, 2021. Primary endpoint was identification of factors associated with development of relevant changes in BD-IPMNs undergoing surveillance including development of worrisome features/high risk stigmata/pancreatic cancer, pancreatectomy, death due to IPMN/pancreatic cancer.

A total of 647 patients had an IPMN at diagnosis, of which 547 (60%) were BD-IPMNs, 87 mixed type IPMN (9%) and 13 (1%) main duct IPMN. 57 (8.8%) patients underwent immediate surgery and 590 (91.2%) active surveillance. During surveillance 34 patients (5.7%) underwent surgery with evidence of malignant IPMNs in 2/3 while 30% had only low-grade dysplasia. Overall pancreatic malignancy rate was 2.7% for low-risk BD-IPMNs and 12.5% for mixed-IPMN undergoing initial surveillance. At multivariate analysis, being active smoker (OR 2.2) and a cyst size >15mm (OR 7.1) at diagnosis were independent risk factors for relevant changes. The combination of cyst size ≤15mm & age >65 was a significant protective factor only at univariate analysis (OR 0.1)

 in BD-IPMN the risk of progression is very low in lesions <15 mm found in non-smokers, >65 years patients.