High Burden of Pancreatic Surgery for Intraductal Papillary Mucinous Neoplasia With Low-Grade Dysplasia and Benign Cysts: A Systematic Review and Meta-Analysis.

BACKGROUND: Intraductal papillary mucinous neoplasms with low-grade dysplasia (IPMNs w/LGD) and benign cysts, including serous cystadenomas (SCAs), are common pancreatic cystic lesions (PCLs) that are better managed conservatively. The burden of patients who undergo surgical resection for these cysts is unknown. Our study aims to estimate the global prevalence of surgical resections for IPMNs w/LGD and benign cysts, as well as the pre-operative misclassification rate among all resected PCLs. METHODS: We searched the literature through September 2023 to identify full-text articles that reported the surgical histopathology of resected PCLs. A proportional meta-analysis was performed using a random-effects model, with prevalence estimates reported as pooled proportions. Subgroup analysis and meta-regression were performed based on use of endoscopic ultrasound (EUS), years of enrollment, and geographic location. RESULTS: Sixteen studies (n = 5830) were identified. Among all surgically resected PCLs, 24% were IPMNs w/LGD (95% CI: 18%-32%), 16% were SCAs (95% CI 13%-19%), 4% were other benign cysts (95% CI: 3%-6%), and 24% were pre-operatively misclassified (95% CI: 16%-34%). Of the resected IPMNs, 62% had LGD (95% CI: 51%-71%). An increasing use of pre-operative EUS is associated with a lower prevalence of resected SCAs (p < 0.05) but has not impacted the rate of resections for IPMNs w/LGD. The pre-operative misclassification of PCLs has significantly decreased over time (p < 0.01), although not significantly influenced by increasing EUS utilization or geographic location. CONCLUSION: One quarter of PCLs are pre-operatively misclassified and ∼44% are surgically resected for benign cysts or IPMNs w/LGD. Implementation of advanced diagnostic tools might improve pre-operative classification and reduce overtreatment of PCLs.