Background Management of benign intraductal papillary mucinous neoplasm (IPMN) of the pancreas is difficult because of the unpredictability of the lesion. Current practice often recommends aggressive surgery at the time of diagnosis. This can lead to significant postsurgical comorbidities and potential perioperative mortality. Many clinicians wonder whether expectant management, including no surgery and serial follow-up, is comparable. We sought to compare surgical versus nonsurgical management of benign IPMNs using decision analysis tools.
Methods We used a Markov process to model progression of disease in both surgical and nonsurgical interventions (Figure 1). The base-case was a 65-year-old female with a 2 cm benign-appearing IPMN. We included literature-derived data concerning survival and transition probabilities. Transitions between benign and malignant cancer states and death were modeled in 1-year transitions, over a lifelong time horizon.
Results Overall and interval survival for benign IPMNs did not differ significantly between the surgical and nonsurgical groups. Sensitivity analyses performed on each of the model's parameters revealed it to be robust.
Conclusions There is no observed survival benefit for patients undergoing surgery for small, benign-appearing IPMNs. Based on this model, conservative management with appropriate follow-up should be considered equal to surgical intervention for these lesions. Further analyses regarding potential cost and quality of life parameters are forthcoming.