The role of age in pancreatic intraductal papillary mucinous neoplasms of the pancreas: Same risk of death but different implications for management

Background: Current guidelines do not address the role of age in the management of intraductal papillary mucinous neoplasms (IPMNs) of the pancreas.Aim: To evaluate whether clinical features and risk for malignancy are affected by patient's age at diagnosis.Methods: In total, 2189 IPMNs, both surgically resected or surveilled, were dichotomized according to a 50-year-old cutoff and compared in terms of pathological features, cumulative risk of developing high-risk stigmata (HRS), overall survival (OS) and disease-specific survival (DSS).Results: Patients <50 years had more frequent abdominal pain (38.5 vs. 22.4%; p<0.01) and acute pancreatitis (20.4 vs. 9.3%; p<0.01) at presentation. Patients >50 years old had more multifocal IPMNs (50 vs. 36.9%; p<0.01), HRS (8.5% vs. 4.3%; p=0.04) and invasive IPMNs (26.6% vs. 17.3%; p=0.03) when resected. Moreover, patients >50 years old had a significantly higher cumulative risk of developing HRS over time, and a significantly lower OS, but similar DSS when compared with those <50 years old.Conclusions: IPMNs diagnosed in older patients are more likely to progress to HRS despite the fact that cancer-related death is not affected by age. The follow-up schedule should not be adjusted according to age, but one should take into account that IPMNs in younger individuals have more time to progress toward malignancy. (C) 2018 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.