Abstract
Background
Mucinous Cystic Neoplasms (MCN) of the pancreas are premalignant cysts for which current
guidelines support pancreatic resection. The primary aim of this systematic review
and meta-analysis is to define the pooled rate of malignancy for MCN.
Methods
A systematic review of eligible studies published between 2000 and 2021 was performed
on PubMed and Embase. Primary outcome was rate of malignancy. Data regarding high-risk
features, including cyst size and mural nodules, were collected and analyzed.
Results
A total of 40 studies and 3292 patients with resected MCN were included in the final
analysis. The pooled rate of malignancy was 16.1% (95%CI 13.1–19.0). The rate of malignant
MCN in studies published before 2012 was significantly higher than that of studies
published after recent guidelines were published (21.0% vs 14.9%, p < 0.001). Malignant
MCN were larger than benign (mean difference 25.9 mm 95%CI 14.50–37.43, p < 0.001)
with a direct correlation between size and presence of malignant MCN (R2 = 0.28, p = 0.020).
A SROC identified a threshold of 65 mm to be associated with the diagnosis of malignant
MCN. Presence of mural nodules was associated with the diagnosis of a malignant MCN
(OR = 4.34, 95%CI 3.00–6.29, p < 0.001).
Conclusion
Whereas guidelines recommend resection of all MCN, the rate of malignancy in resected
MCN is 16%, implying that surveillance has a role in most cases, and that surgical
selection criteria are warranted. Size and presence of mural nodules are significantly
associated with an increased risk of malignant degeneration, small MCN and without
mural nodules can be considered for surveillance.
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Article info
Publication history
Published online: March 08, 2023
Accepted:
March 3,
2023
Received:
October 29,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2023 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved.
