Comorbidity Burden in Active Pancreatic Cyst Surveillance Population: 48

Introduction: Pancreatic cyst surveillance is recommended for presumed mucinous cystic neoplasms. Among these patients who have a low lifetime risk of malignancy, the challenges of accurate preoperative diagnosis must be weighed against the surgical candidacy and overall survival. Recently the Charlson Comorbidity Index (CACI) has been suggested as a useful way to determine which patients should continue in active pancreatic cyst surveillance. However, this has only been studied in predominantly surgical population. We aim to determine the comorbidity burden of the pancreatic cyst population undergoing active surveillance at a tertiary centre in the year 2016 through utilization of CACI. Methods: A cross sectional study of all the patients with presumed mucinous lesions undergoing active surveillance at a single institution during 2016 was performed. The patients included were diagnosed at least one year prior to the study year, and were undergoing surveillance imaging of the cyst during the study year. A presumed mucinous pancreatic cyst diagnosis was made based on the accepted criteria from the literature including the presence or absence of high risk stigmata (HRS) or worrisome features (WF). The electronic medical record was reviewed to calculate CACI and 10-year survival probability for each patient.The data acquired was nonparametric and expressed as median and interquartile range (IQR). Results: The study included 507 patients with pancreatic cystic neoplasms (PCNs), among which, 51 had WF, and 12 had HRS. The population of all PCNs had median age of 68(IQR 60-75) years and cyst size of 10(IQR 5-17) mm. The median CACI was 4(3-5), and a value of ≥ 7 was found in 74(14.59%) patients.(Table1) Among patients with HRS and WF, it was 3.5 (IQR 3-5) and 4 (IQR 3.25-5) respectively. (p=0.80) The 10-year survival probability calculated for all PCN population was 2.24%(IQR 0-53.39%). As our medical center has large cancer and liver program, upon exclusion of the cases with malignancy or established liver disease, the median CACI score for 378 patients reduced to 3(IQR 3-5) and value of ≥7 was found in 27 patients (7.14%).(Table2) Conclusion: The non-surgical surveillance population for presumed mucinous neoplasm at our centre has a comparable burden of comorbidity, similar to previous predominantly surgical series, even after exclusion of patients with malignancy and chronic liver disease.Incorporation of CACI into clinical decision making for cyst surveillance warrants further investigation.48_A Figure 1. All Population48_B Figure 2. Population excluding liver disease and neoplasms