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 Preemptive pancreatic surgery Ann Morgell, Division of Surgery [email protected] Pancreatic Cystic Neoplasms (PCNs) are a very frequent medical condition with a prevalence of about 20‐30% in the general population. Some of these neoplasms are premalignant lesions that can progress to cancer whereas others are essentially benign. The accuracy of the preoperative differential diagnosis of PCNs is only around 60%, even in expert centers. Hence, while it is currently straightforward to detect PCNs, the discrimination between benign PCNs and cysts with malignant potential is very difficult. Since the incidence of PC is ‐10/100000 inhabitants, only a minority of PCNs will progress to cancer. Thus, there is a risk of over‐ or undertreatment of patients with PCNs and a need for lifelong follow‐up of a vast number of patients in order to detect potential transformation to cancer. The aim of this project is to increase the accuracy in differential diagnosis of PCNs, to identify more accurate risk factors for predicting malignancy risk in subjects affected by precursor lesions, to optimize the cost/effectiveness of the current surveillance protocols and finally, to describe the spectrum and significance of radiologic findings in patients with increased familial and genetic risk of pancreas cancer. The first study is a prospective study in a cohort of patients affected by PCNs that are candidates for surgical treatment. A new immunological analysis of immune cells that infiltrate into PCNs allow for a detection of molecularly defined targets that are exclusively expressed in PCNs, yet not in pancreatic cancer. Ultimately, this will aid to define markers that allow to discriminate between lesions at high or low risk to cancer progression. The 2nd study aims to define an age when the surveillance can be discontinued because the risk/yr to die for other reason is overcoming the risk of cancer transformation. The 3rd study will analyze the risk of pancreas cancer in a population of patients affected by PCNs under surveillance and will identify new clinical and radiological markers for PCN malignification, useful for preemptive pancreatic surgery. The 4th study aims to describe the type, incidence and significance of pancreatic radiologic findings in a group at increased familial and genetic risk for PC in order to predict who should undergo preemptive pancreatectomy and when. An ethical approval is obtained for study 2 and 3. For study 1 and 4 we are submitting an amendment for an already existing ethical approval for a similar study regarding PC.