Real-world costs and dynamics of surveillance in patients who underwent surgery for low-risk branch duct intraductal papillary mucinous neoplasms

Surveillance costs and appropriateness of surgery of "low-risk" BD-IPMNs are relevant issues. In this study we evaluated the rate of correct indication for pancreatectomy defined as high grade dysplasia (HGD) at histology in 961 patients who underwent surveillance for a median of 5.1 years. Undertreat-ment and overtreatment were defined as invasive cancer and low grade dysplasia (LGD) at histology, respectively. Of the 66 patients (6.9%) who were operated, only 16 (23.8%) had a HGD while 40 (59.7%) had a LGD and 10 (14.9%) an invasive cancer, without differences regarding timing of surgery. The mean surveillance cost was euro 194.9 +/- 107.6 per patient-year, with a median cost of euro 277.1 +/- 148.2 in the correct surgery group compared with euro 222.7 +/- 111.6 and euro 197 +/- 102.7 in the overtreatment and undertreatment groups. The surveillance mean cost from diagnosis to surgery was euro 854.8. Rate of appropriate surgery in BD-IPMNs under surveillance is low.(c) 2022 Published by Elsevier Ltd.