Oral Presentation The Pancreas Summit 2025

The Changing and Persistent Landscape of Pancreatic Cystic Lesions: A Three-Decade Prospective Single-Center Experience with Over 5,000 Consecutive Cases (125909)

Hiroki Oyama 1 , Tsuyoshi Hamada 1 , Shinya Takaoka 1 , Wataru Gonoi 2 , Mika Kaihatsu 1 , Sachiko Kanai 1 , Yoshikuni Kawaguchi 3 , Takahiro Kishikawa 1 , Kensaku Noguchi 1 , Tatsuya Sato 1 , Naminatsu Takahara 1 , Mariko Tanaka 4 , Kiyoshi Hasegawa 3 , Tetsuo Ushiku 4 , Osamu Abe 2 , Kazumichi Kawakubo 5 , Yousuke Nakai 6 , Naoki Sasahira 7 , Hiroyuki Isayama 8 , Minoru Tada 9 , Max Petrov 10 , Mitsuhiro Fujishiro 1 , Masao Omata 11
  1. Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Bunkyo-city, Tokyo, Japan
  2. Department of Radiology, Graduate School of Medicine, The University of Tokyo, Bunkyo-city, Tokyo, Japan
  3. Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Bunkyo-city, Tokyo, Japan
  4. Department of Pathology, Graduate School of Medicine, The University of Tokyo, Bunkyo-city, Tokyo, Japan
  5. Department of Gastroenterology and Hepatology, Graduate School of Medicine, Hokkaido University, Hokkaido, Japan
  6. Department of Internal Medicine, Institute of Gastroenterology, Tokyo Women’s Medical University, Shinjuku-city, Tokyo, Japan
  7. Department of Hepato-Biliary-Pancreatic Medicine, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, Koto-city, Tokyo, Japan
  8. Department of Gastroenterology, Graduate School of Medicine, Juntendo University, Bunkyo-city, Tokyo, Japan
  9. Department of Gastroenterology, National Hospital Organization Chiba Medical Center, Chiba, Japan
  10. School of Medicine, University of Auckland, Auckland, New Zealand
  11. Department of Gastroenterology, Yamanashi Central Hospital, Yamanashi, Japan

Background & Aims: The profile of patients presenting with pancreatic cystic tumors has evolved over the past decades.  We described our prospective institutional experience, focusing on the trajectory of clinical presentation and patient outcomes in relation to the development and revisions of international guidelines.

Methods: We analyzed 5,436 patients diagnosed with pancreatic cystic lesions between 1994 and 2023, including 4,796 patients with cystic tumors.  Temporal trends in clinical characteristics were assessed according to the periods corresponding to the respective versions of the international guidelines.  In the long-term surveillance cohort of intraductal papillary mucinous neoplasms (IPMNs), the cumulative incidence of pancreatic carcinoma was estimated.

Results: The majority of tumors (> 95%) were IPMNs throughout the study period.  An increasing number of pancreatic cystic tumors were identified incidentally during medical check-ups and at smaller sizes (< 10 mm).  The evolving guidelines have influenced clinical practice, leading to a shift toward more conservative management and improved patient adherence to the standard surveillance program.  The cumulative incidence of pancreatic carcinoma overall remained approximately 3.0% at five years of follow-up across all periods.  While the detection of early-stage carcinoma derived from IPMN increased, a substantial proportion of carcinomas concomitant with IPMN continued to be identified at stage ≥ 3, with 35% during the period covered by the 2017 guidelines.

Conclusions: Our 30-year experience indicates that pancreatic cystic tumors have been—and continue to be—a clinically significant disease entity.  Research is warranted to develop new management strategies for patients with IPMNs targeting carcinomas arising concomitantly with IPMN.