Pancreatic Cysts in the Geriatric Sphere: A Call for Close Consideration of Patient Characteristics in Pancreatic Cyst Management

Increasing use of high-quality abdominal imaging has been associated with a rise in the detection of pancreatic cysts. The incidence of intraductal papillary mucinous neoplasm (IPMN), the most common pancreatic cyst type, increases with age. The purpose of this review is to present a framework for management, whereby care is tailored according to the risk of the cyst, patient characteristics, and patient preferences.

Studies have shown that the cumulative incidence of pancreatic cancer rises over time for patients with IPMNs. Nonetheless, small branch-duct IPMNs constitute the majority of identified cysts in older patients, and growing data suggest that there is a low-risk of malignant transformation for such cysts that exhibit stability over 5 years. Moreover, cohort studies of older patients with IPMNs have reported a low incidence of pancreatic cancer.

Further, while there have been studies of pancreatic cyst outcomes stratified by age and comorbidity burden, an additional patient characteristic worth addressing is frailty, which has been associated with outcomes for cirrhosis and inflammatory bowel disease.

Most pancreatic cysts identified in older adults will not progress to pancreatic cancer. Thus, a multidisciplinary approach, in which management is guided by both the cyst risk and patient’s overall preferences and prognosis, should be employed to achieve patient-centered care.