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. 2019 Aug 22;19(1):115.
doi: 10.1186/s12893-019-0580-y.

Intraductal papillary mucinous neoplasms of the pancreas and European guidelines: importance of the surgery type in the decision-making process

Etienne Buscail  1   2   3 , Thomas Cauvin  4   5   6 , Benjamin Fernandez  4   6 , Camille Buscail  7 , Marion Marty  8 , Bruno Lapuyade  9 , Clément Subtil  10 , Jean-Philippe Adam  4 , Véronique Vendrely  5 , Sandrine Dabernat  5 , Christophe Laurent  4   5   6 , Laurence Chiche  4   5   6
Affiliations

Intraductal papillary mucinous neoplasms of the pancreas and European guidelines: importance of the surgery type in the decision-making process

Etienne Buscail et al. BMC Surg. .

Abstract

Background: The 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.

Methods: Clinical, 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.

Results: 124 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).

Conclusion: Considering 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.

Keywords: European guidelines; IPMN; Pancreatic resection; Post-operative morbidity.

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Conflict of interest statement

No conflict of interest to declare

Figures

Fig. 1
Fig. 1
Number of pancreatectomies for IPMN between 2007 and 2017 and surgery complications. a: Number of pancreatic resection for pancreatic ductal adenocarcinoma (PDAC) (grey bars) and for IPMN (black bars) during the study period. b: Number of patients with post-surgery complications among the 124 patients who underwent pancreatectomy (all procedures) and subdivided according to the type of IPMN at the post-surgery histological analysis (n = 62 benign IPNM and n = 62 malignant IPMN). c: Comparison of post-surgery complications in the 49 patients who underwent distal pancreatectomy and subdivided according to type of IPMN at the post-surgery histological analysis (n = x benign IPNM and n = x malignant IPMN). d: Comparison of post-surgery complications in the 75 patients that underwent pancreaticoduodenectomy and total pancreatectomy and subdivided according to type of IPMN at the post-surgery histological analysis (n = 29 benign IPNM and n = 46 malignant IPMN). b-d: Grey bars, grade I-II complications; black bars, grade III to V complications, according to the Dindo-Clavien classification
See this image and copyright information in PMC

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