Abstract
BackgroundThe European Consensus 2018 established a new algorithm with absolute and relative criteria for intraductal papillary mucinous neoplasms of the pancreas (IPMN) management. The aim of this study was to validate these criteria and analyse the outcomes in function of the surgical procedure and IPMN subtype.MethodsClinical, radiological and surgical data (procedure, morbidity/mortality rates) of patients who underwent surgery for IPMN between 2007 and 2017. The predictive value of the different criteria was analysed.Results124 patients (men 67%; mean age 65 years) underwent surgery for IPMN (n = 62 malignant tumours; 50%). Jaundice, cyst ≥4 cm and Wirsung duct size 5–9.9 mm or ≥ 10 mm were significantly associated with malignancy (4.77 < OR < 11.85 p < 0.0001). The positive predictive value of any isolated criterion ranged from 71 to 87%, whereas that of three relative criteria together reached 100%. The mortality and morbidity (grade III-IV complications according to the Dindo-Clavien classification) rates were 3 and 8%, respectively. Morbidity/mortality after duodenopancreatectomy and total pancreatectomy were significantly higher for benign IPMN (p = 0.01).ConclusionConsidering the morbidity associated with extended surgery, particularly for benign IPMN, the results of the present study suggest that high-risk surgery should be considered only in the presence of three relative criteria and including the surgery type in the decision-making algorithm.
Highlights
The European Consensus 2018 established a new algorithm with absolute and relative criteria for intraductal papillary mucinous neoplasms of the pancreas (IPMN) management
Malignancy rate and histological subtype distribution were comparable in branch duct (BD) and main pancreatic duct (MD)/mixed IPMN samples
Comparison of the diagnostic performances of each imaging technique for recognizing BD and MD/mixed IPMN (Additional file 1: Table S1 and Additional file 2: Table S2) indicated that Computerized tomodensitometry (CT) was more suitable for the diagnosis of BD IPMN, while Magnetic resonance cholangiopancreatography (MRCP) was the
Summary
The European Consensus 2018 established a new algorithm with absolute and relative criteria for intraductal papillary mucinous neoplasms of the pancreas (IPMN) management. Several guidelines have been established to define the surgery criteria, depending on the presence or not of “worrisome signs” and “high risk stigmata of malignancy” (i.e., high grade dysplasia and invasive carcinoma) [5,6,7,8]. Several European societies (i.e., the European Study Group on Cystic Tumours of the Pancreas, United European Gastroenterology, European Pancreatic Club, European-African HepatoPancreato-Biliary Association, European Digestive Surgery, and European Society of Gastrointestinal Endoscopy) published updated evidence-based guidelines for the management of pancreatic cystic neoplasms [9, 10].
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